Consent Form

Name of student athlete *This question is required.

Student's Nominator

Student's School

I certify that I am the parent or legal guardian of the student athlete listed on this form and hereby grant permission for him/her to participate in the Adena Athlete of the Month program. This may include his/her name and/or photo being used on the internet/social media, in local newspaper ads or news releases, on the radio, hospital advertisements and other publications. Please be aware that an electronic signature is as legally binding as a handwritten signature. Forging a signature may not only disqualify the student athlete but also is punishable by law. *This question is required.

Yes, I acknowledge that I have read and understand these notices.

Electronic signature of parent or legal guardian of student athlete *This question is required.

Consent Form

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