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x. 0 0 0 2 5 9 1 5. Amy Sabo. Sarah Rawson Smith Elem PTA. 370 Ivy Road NE. Atlanta, GA 30342. a myjsabo gmail.com. 404 802-3850. 9 /3 / 13. 9 /28/ 12. 4/10/07. Page 1 of 3. Page 2 of 3.

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  1. x 0 0 0 2 5 9 1 5 Amy Sabo Sarah Rawson Smith Elem PTA 370 Ivy Road NE Atlanta, GA 30342 amyjsabo gmail.com 404 802-3850 9 /3 / 13 9 /28/ 12 4/10/07 Page 1 of 3

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  3. I give my permission for my son/daughter, _____________________, to participate in the taping, filming, photographing, writing, creating of an entry for the 2013-2014 Reflections program. I give consent for my child’s image or voice to be included in the entry. This entry may be used in perpetuity in connection with the PTA Reflections program or other PTA purposes. I understand that entries may be judged at the local, regional, state and national competitions. I give my permission for my child’s entry in any of the five Reflections categories to be displayed at a school or other public area, including the Internet and Shutterfly sites related to the Sarah Smith Reflections program. I have read and understand the Rules of the Reflections Program. Artwork Title Student Name Parent / Guardian Printed Name Parent / Guardian Signature Date Page 3 of 3

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