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* I hereby give my written consent to the Pennsylvania Department of Education located at 333 Market Street, Harrisburg, Pennsylvania, its successors, assigns and licensees and any agencies designated by Pennsylvania Department of Education, to create audio recordings of my minor child and disseminate or otherwise share such recordings via digital media and/or the internet wherever, whenever, and in whatever manner they shall desire, consistent with good taste which will not be derogatory, degrading or detrimental to me or my minor child in any way. I understand that neither I nor my minor child will receive any compensation, now nor in the future, for the above. I release all claims to and/or arising out of these audio recordings and assign all rights to these recordings to Pennsylvania Department of Education.

I confirm that I am at least 18 years of age and have read and agree to this Consent to Use Voice. I confirm that this release shall be binding upon my heirs, legal representatives, and assigns.

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* Your Name

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* Date

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* Email

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* Phone Number

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* If the subject is a Minor child, a Parent or Legal Guardian is to sign below:

I am the Parent/Legal Guardian of the below-named minor child and confirm that I have the full legal capacity to consent to the use audio recordings on behalf of my minor child. I have read and agree to this Consent to Use Voice on behalf of my minor child. I confirm that this release shall be binding upon the heirs, legal representatives and assigns of my minor child.

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* Date

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* Parent/Legal Guardian Name

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* Parent/Legal Guardian Email

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* Parent/Legal Guardian Phone 

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* .mp4 or .wav file upload (Non-anonymous question)
 

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.