Today's date

Academic, mental, physical, etc. Please explain clearly.

Allergy, asthma, food allergy, etc. Please explain clearly.

I hereby grant permission to What Now America to photograph me or my child during activities to use the photographs in What Now America audio-visual, website and printed materials without compensation or approval rights.

The information that I have provided is to the best of my knowledge and belief, true, correct and complete. I agree to release What Now America from all liability, claims and loss or damage arising out of the participation of my child in the program.