Student 1 Name *

First Name

Last Name

Student 2 Name (if applicable)

First Name

Last Name

Student 3 Name (if applicable)

First Name

Last Name

I _____ give permission and consent to WEB (Weekday Eastside Bridge) for the use of photograph(s) or electronic media images of my student at WEB for the use of the WEB website, WEB Facebook page and/or WEB Instagram account. *

Do

Do Not

Parent/Guardian Name *

I understand and agree this is a legal representation of my signature.

First Name

Last Name