MEDIA RELEASE: Sign and Bring on March 22

New Hampshire Poetry Out Loud 2016-2017

Media Release Form

Please sign and return this form by email or mail to

NH POL Coordinator,

Julianne Gadoury at

New Hampshire State Council on the Arts
19 Pillsbury St. 1st floor

Concord, NH 03301

Please return ASAP. All students will need a signed release before competing in the semi-final or state final events.

As Parent/Guardian, I/we, ________________________________________________

grant permission for our child: _____________________________________________,

(Please print clearly)

age______, and who attends______________________________________________

(School Name)

______________________________________(town)

to participate in any and all activities associated with the 2016-2017 New Hampshire Poetry Out Loud Program, and to be photographed and recorded as part of the New Hampshire Poetry Out Loud events. Such photos, videos, and audio may be used for publicity, reports and archival purposes by the NH Poetry Out Loud Project, on the NH Poetry Out Loud website and social media platforms, by the national Poetry Out Loud Program, and in promotion of the NH Poetry Out Loud Program. NH Poetry Out Loud is a program managed by the NH State Council on the Arts, www.nh.gov/nharts

Print parent/guardian's name: _____________________________________________

Signature: ___________________________________________Date: _____________