| SCHOOL NAME: ______________________ CITY & STATE: ________________________ |
MAIL TO: National Academic Association 1540 Siesta Dr. Sandy, UT 84093 |
KNOW ALL MEN BY THESE PRESENT: I, the undersigned, for the purpose of enabling ____________________________ (student's full name), a minor, to participate in the National Academic Championship and all related activities, do hereby release the National Academic Association, Questions Unlimited, Hilton DFW Lakes Resort, Marymount University, Holiday Inn, and their employees, representatives, or agents and all representatives or agents involved with the said academic championship as follows:
I have read and understand its terms. I execute it voluntarily with full knowledge of its significance, and with the intention of binding myself.
Dated this ______ day of ___________, 2008
| __________________________ | ___________________________ | |||
|---|---|---|---|---|
| Father or Legal Guardian | Mother or Legal Guardian |
| City, State, ZIP | Home Telephone Number |