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Tell Us Why You (or someone You know) Should be a Star Student

 

 

Why Not?

 

 

ShakeShock.com has a slogan, “Using the artists of tomorrow to honor the artists of yesterday.”  We say this because we believe art does not exist in a vacuum.  It is affected by its surroundings and its peers of the time.

 

Over time, the loss of iambic pentameter, and the innovation of conventions like hip-hop and MTV have changed how we look at all other art.  Even though the context has changed, the raw and powerful emotions that inspired these literary works are still present.  So, we encourage young artists to take poems of great literature, and adapt them into short videos, using visual metaphors to express the ancient meaning.

 

The poems available to you are wide open (Shakespearean sonnets, Greek Tragedies, Haiku, or short stanzas as little as one-hundred years old), and so are the methods you can use to make your short films (artful montage, to huge cartoon explosions, to sock puppets). 

 

So print THIS form, mail it in to the address below, and THEN your short Dockey could be eligible to win $300 cash.

 

And yes, you have to fill out all of it.  Don’t worry, it’s not as scary as it looks.

 

             

 

Dockey Rules and Regulations

 

 

If you want to just upload your video, that’s cool, but if you want to be eligible for the competition, and the prize, then Print, Read, and Mail In The Whole Agreement

 

But here's the gist of it.

 

·         By signing this, you give ShakeShock.com, and all it's employees, representatives, and successors, the permission to display your video.

 

·         You must be a minimum of 13 years old to submit an entry.

 

·         If you are under 18, you must have your parent/guardian sign a release form.

 

·         You cannot submit a video to our competition if you are running for a public political office. 

 

·         You will be disqualified if it turns out you, or any members of your family are associated with our website (it would be seen as favoritism).

 

·         The Poem you base your video Dockey on must be at least 100 years old.

 

·         The video Dockey cannot be longer than 5 minutes.

 

·         You must also submit a video introducing yourself, which must be 30-45 seconds long.  It will be for the website, so don't give out any personal info, just talk about yourself and why you made adapted this poem, and in this style.

 

·         All videos must be under 100 mb in size.

 

·         You can submit as many videos as you want.

 

·         Your videos will not be considered officially submitted until ShakeShock.com has received the signed copies of all your paperwork (and for God's sake, write clearly, and staple them together).

 

·         You must upload your video, and list Dockey as one of the keywords.  If you cannot upload your video for technical reasons, then you can mail it in, and we'll upload it for you.  We're nice like that.  :)   But don't push it.  >:(

 

·         All materials must be received by May 1, 2008. 

 

·         The winner will receive a cash prize of $300.

 

·         And finally, no nudity, unnecessary violence, or vulgarity.

 

 

 

Make Sure Your Paperwork is in order

 

Actor release form for ShakeShock.com Short Dockeys.

Crew deal memo form for ShakeShock.com Short Dockeys.

Still photo release form for ShakeShock.com Short Dockeys.

Music submission release form for ShakeShock.com Short Dockeys.

Budget template for ShakeShock.com Short Dockeys.

 

 

 

APPLICATION RULES AND REQUIREMENTS:

This application (“Application”) is for participation as a contestant in an online short film competition whose purpose is entertainment. You must satisfy all eligibility requirements and submission guidelines set forth herein in order for your Application to be considered by Producer (defined in Paragraph A.VI below).

 

Along with your Application, you must submit a short film or video entry that meets the submission requirements herein, for Producer’s consideration. Please carefully read this Application and only submit an Application if you (i) meet all requirements and fully and completely agree to comply with all of the terms and conditions set forth herein and (ii) submit a short film or video pursuant to the requirements and submission instructions set forth herein and on the ShakeShock.com Website (“ShakeShock.com Website”).

 

  1. Eligibility Requirements: The following eligibility requirements must be met in order to proceed with the application process:

 

I.              You must be at least 13 years of age at the time of application. However, if you are under 18 years of age, your parent or guardian must execute the “Parental Consent” form attached to this Application in order to be eligible.

 

II.            You must follow the directions set forth in this Application. The completed Application, and all materials submitted therewith, will not be returned to you.

 

III.           Applications MUST be written clearly or typed. Please do not include anything except the completed Application forms and the Submission (As defined in paragraph B below).

 

IV.          All applicants who believe they meet our criteria, including persons with disabilities, are welcome and encouraged to apply to be a participant.

 

V.           You must not now be a candidate for public office and must agree not to become one until six months after initial broadcast of all Website materials, shorts, and Dockeys in which you appear.

 

VI.          Neither you nor any of your immediate family members or anyone living in your household may be or have been within the past two years employees, contractors, officers, directors or agents of any of the following: (a) Richard D. Tucci or Tucci Enterprises (“Producer”); (b) any sponsor of the Website or its advertising agency; or (c) any person or entity supplying services to the Website. In addition, Producer reserves the right to render ineligible any person who Producer determines, in its sole discretion, is sufficiently connected with the production, administration, judging, or distribution of the Website such that his or her participation in the Website could create the appearance of impropriety.

 

  1. Short Film Submission Requirements: Any short film and/or video that you submit along with this application (“Submission”) must meet the following requirements:

 

              I.    CONTENT: The Submission shall consist of both (1) a 30-90 second introduction of your Submission and yourself as a filmmaker (“Intro Video” to be uploaded as a separate file) and (2) a “short” film or video which has a beginning, middle and end in a broad sense based upon a pre-approved piece of classical poetry (“Short”). The Submission may be any poem (i.e. Shakespearean Sonnet; Haiku; Greek poetry; etc.) as long as it is pre-approved by ShakeShock.com judges, and may be in any genre (other than pornographic) and must be in English. You must be the director of the Submission, though it may be edited by someone else. You must own and control all rights to the Submission to the extent required under the Submitted Materials Release attached hereto and incorporated in this application.

 

            II.    Submissions may not contain nudity, excessive profanity, use of obscene language or gestures or any depiction of real or simulated sexual acts, extensive violence or any actual illegal acts or written descriptions thereof. Submissions should not contain references to actual people and events, other than references to people and events in the public domain, or to your personal history in the Intro Video. Submissions may not contain any derogatory references to Producer, or any affiliated entity or person thereof or any announced promotional partners.

 

           III.    LENGTH: THE INTRO VIDEO SHALL BE A MINIMUM OF THIRTY SECONDS AND A MAXIMUM OF NINETY SECONDS, AND THE SHORT SHALL BE MAXIMUM OF FIVE MINUTES.

 

          IV.    FILE SIZE AND FORMAT: Maximum file size of 100 MB.

 

           V.    E-MAIL ADDRESS: Each entrant submitting a Submission must be the rightful owner (or have authorized use) of the e-mail address identified in the Application below.

 

          VI.    NUMBER OF SUBMISSIONS: There is no limit of submissions per person.  Any participant can enter as many entries as willing. 

 

         VII.    ANY SUBMISSIONS THAT EXCEED THE FOREGOING LENGTH, SIZE AND FORMAT REQUIREMENTS MAY NOT BE CONSIDERED BY PRODUCER.

 

  1. How to Send in Your Submission: In order for your Submission to be considered you must submit your Submission in the following manner:

 

I.              You must upload your Submission directly onto the ShakeShock.com Website (“Uploaded Submission”).  Both videos (your director’s video, and your short poetry adaptation) must be uploaded as separate files.  Your Uploaded Submission will not be posted to the viewable ShakeShock.com Website, nor viewed by any person unless and until Producer approves your entry.  They must also include the word Dockey in the KEYWORD or TAGS section to be considered eligible.

 

II.            Your video will not be considered under official competition, until Producer’s have received your fully completed and signed Application, which shall be submitted pursuant to the instructions below. Submissions without cleared music and scoring (i.e., you own or have obtained the rights to use such music and scoring), as set forth in Section 5 of the Submitted Materials Release, will not be posted on the ShakeShock.com Website and shall be only submitted for consideration by Producer using the procedures set forth below.

 

III.           PLEASE NOTE, ONE OR MORE OF THE CONSIDERATIONS THAT PRODUCER MAY USE IN DETERMINING WINNING SELECTIONS MAY BE BASED ON VIEWERSHIP, FEEDBACK, AND/OR VOTING ON SUBMISSIONS BY THE GENERAL PUBLIC ON THE SHAKESHOCK.COM WEBSITE. IF YOU CHOOSE TO SUBMIT A SUBMISSION THAT DOES NOT CONTAIN CLEARED MUSIC AND SCORING, YOU SHALL FORFEIT YOUR RIGHT TO BE INCLUDED IN ANY SUCH ASPECT OF THE SELECTION PROCESS.

 

IV.          In order to upload your Submission directly onto the ShakeShock.com Website, please follow the instructions on the ShakeShock.com Website listed under “SUBMIT FILM.” IF YOU CHOOSE TO UPLOAD YOUR SUBMISSION, PLEASE PRINTOUT, REVIEW, SIGN AND MAIL ALL APPLICABLE SIGNED RELEASE FORMS LISTED IN PARAGRAPH D.1.a. BELOW TO THE ADDRESS BELOW IN ORDER FOR YOUR UPLOADED SUBMISSION TO QUALIFY.

 

V.           DO NOT mail in a copy of your video submission.  ONLY UPLOAD IT DIRECTLY TO THE SITE.

 

  1. Additional Requirements / How to Submit Your Application:

 

              I.    Applications will only be considered if they are complete and properly submitted pursuant to this Application. Complete Applications consist of the following:

a.    Signed originals of the following documents:

(1)  Application Rules and Requirements

(2)  Applicant Information Sheet

(3)  Submitted Materials Release

 

SUBMISSIONS WITHOUT EACH OF THESE SIGNED DOCUMENTS ARE INELIGIBLE FOR PARTICIPATION AND WILL NOT BE VIEWED.

 

            II.    The Deadlines for Applications: Your completed Application must be submitted by the following date:

b.    Uploaded Submission: The deadline is December 1, 2007.

           III.    Where to Send your Application: Your completed and signed Application Rules and Requirements, and Applicant Information Sheet must be sent with proper postage affixed or pre-paid shipping to:

 

ShakeShock.com

Short Dockey Poetry Competition

5824 1/2 Harold Way

Los Angeles, CA 90028.

 

          IV.    The completed Application, and all materials uploaded and submitted therewith will become the property of the Producer and will not be returned to you, whether or not you are selected as a winner. The decision of whether to post the Submission onto the ShakeShock.com Website and how long the Submission is posted for public viewer-ship is at Producer’s sole discretion. Producer is not required to post any submitted material on the ShakeShock.com Website. All dates and locations in this Application are subject to change in Producer’s sole discretion. Producer’s decision not to enforce a specific provision of these Application Rules and Requirements does not constitute a waiver of that provision or of the Application Rules and Requirements generally. In addition, Producer reserves the right to modify the Application Rules at any time and from time to time.

 

Please read, sign and date the following statement:

 

I hereby acknowledge that (i) I have read, and I meet and agree to be bound by, the Website eligibility requirements; (ii) I have answered all of Producer’s questions honestly and accurately; (iii) if any of the submitted information is found to be false, I understand that this may be grounds for my dismissal from the Website Competition, if selected; (iv) even if I meet the eligibility requirements, the Producer has no obligation to select me as a winner; (v) all decisions by the Producer concerning the selection of the winners is final and not subject to challenge or appeal; (vi) my voice, actions, and likeness may be recorded as a part of this Application and winner selection process, and I understand that Producer may, but are in no way obligated to, actually use such recordings within the Website; (vii) all decisions by Producer concerning selection of the winners are final and not subject to challenge or appeal; and (viii) Producer has no obligation to return any materials submitted by me as part of the winner selection process (including all Submissions provided to Producer) whether or not I am selected as a winner, and Producer may, but is in no way obligated to, use gratis any such materials in perpetuity, in and in connection with the Website, throughout the universe, in any and all media now known or hereafter devised.

 

Signature: ______________________________

 

Date: _________________________________

 

Name (please type or print clearly): _____________________

 

Title of Short Dockey: _____________________________

 

Title of Classic Poem Short was based on: ____________________

 

I have obtained all necessary rights to grant you the right and/or to permit you to use all music and scoring incorporated in the Submission in any and all media, including but not limited to the Internet:

 

YES: ____ NO: ____

 

             

APPLICANT INFORMATION

FIRST NAME: ____________________________________

 

LAST NAME: ____________________________________

 

STREET ADDRESS: ________________________________

 

CITY: _______________ STATE: __________ ZIP: _________

 

CELL PHONE: _______________________

 

HOME PHONE: _______________________

 

WORK PHONE: _______________________

 

EMAIL: _______________________

 

YOUR SHAKESHOCK USERNAME: _______________________

 

GENDER (PLEASE CIRCLE): MALE / FEMALE

 

AGE: _______ DATE OF BIRTH: ______________

 

TITLE OF SHORT DOCKEY _______________________________

 

CLASSIC POEM DOCKEY IS BASED ON ________________________

 

________________________________________________

 

GENRE OF DOCKEY? [ ] DRAMA [ ] COMEDY [ ] ACTION/ADVENTURE

      [ ] HORROR [ ] OTHER

 

GIVE BRIEF SYNOPSIS OF WHAT THIS PIECE MEANS TO YOU.

________________________________________________

 

________________________________________________

 

________________________________________________

 

________________________________________________

 

 [ ] COLOR [ ] BLACK & WHITE [ ] BOTH

 

SUBTITLING YES/NO _________

 

IF YES IN WHAT LANGUAGE?

______________________________________

 

HAS YOUR FILM RECEIVED ANY AWARDS? YES/NO ____________

 

IF YES PLEASE LIST (and don’t forget to put them in the tags). ________________________________________________

 

________________________________________________

 

CURRENT OCCUPATION: ________________________________

 

WHAT IS YOUR LEVEL OF EDUCATION? _______________________

 

IS THERE ANY THING ELSE YOU WANT US TO KNOW?____________

 

I represent that the information in this Application Information Sheet is truthful and accurate.

 

By: _____________________________

 

Date: ____________________________

 

 

SUBMITTED MATERIALS RELEASE

Date:_______________________

 

“ShakeShock.com” / INTERNET POETRY ADAPTATION COMPETITION

c/o Tucci Enterprises ( “Producer”)

 

To Whom It May Concern:

 

I would like to submit the enclosed entry for your Poetry Adaptation Competition on ShakeShock.com currently entitled “ShakeShock.com Poetry Adaptation Competition” (“ShakeShock.com”). Accordingly, I desire to submit to you material, which shall include, but not be limited to the Submission (as defined in the Application attached hereto and incorporated by this reference) (herein called “submitted material”) owned and/or controlled by me so as to offer you the opportunity to decide whether you want to consider me to be a participant (“Participant ”) on the ShakeShock.com competition. The submitted material is described as follows (to be described in 100 characters or less):

 

_______________________________________________

 

 

_______________________________________________

 

 

I acknowledge and agree that, but for my agreement to the terms set forth herein, you would not agree to accept for consideration, post on the ShakeShock.com Website, or review the submitted material. Accordingly, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby acknowledge and agree to the following:

 

1.      I acknowledge and agree that unless and until I execute such Participant Agreements, you will not consider me as a possible Participant for the ShakeShock.com competition, and that you are accepting my submitted material in reliance on my completion and execution of the Participant Agreements. If I am a minor I acknowledge and agree that I will need a parental consent form for each of the forgoing in order to be considered as a Finalist.

 

2.      I shall not receive any compensation or credit for submitting the submitted material to you, and understand that you and the general public may view the submitted material. I further understand that you and the general public may vote on, post comments in connection with, and view the submitted material on The ShakeShock.com Website without limitation, and I shall not receive any compensation or credit for the same. I acknowledge and agree that once I provide you with the submitted material, it is at your discretion whether to post it on The ShakeShock.com Website, and how long you shall keep it posted for public viewer ship. I understand you are not required to post my submitted material on The ShakeShock.com Website.

 

3.      I hereby grant to Producer, their assigns and affiliates the perpetual, irrevocable right and license to distribute, broadcast, and otherwise exploit the submitted material, gratis, throughout the universe, in any and all manners, formats and media, whether now known or hereafter devised, in connection with The ShakeShock.com Website, or otherwise, including, but not limited to, the non-exclusive, fully paid, universal license to use, copy, digitize, sublicense, transmit, distribute, publicly perform, publish, delete or display such submitted material, or any portion thereof, in any media now known or hereafter devised including, but not limited to The ShakeShock.com Website. I authorize you, and any entities affiliated or in privity with you, to utilize on a non-exclusive basis, for eternity and in any manner you see fit, the submitted material to you, and to make derivative works from such materials. I agree that such use shall be freely assignable by you, and that you and your assignees and licensees shall have no obligations whatsoever to me. I hereby grant you permission to and you shall have the right and sole discretion to edit, alter, modify or change any part of the submitted material for any reason in connection with your (or your assignee’s or licensee’s) use thereof.

 

4.      I recognize the possibility that the submitted material may be identical with or similar to material which has or may come to you and/or your affiliates from other sources. Such identity or similarity in the past has given rise to litigation so that unless you can obtain adequate protection in advance, you will refuse to consider or post the submitted material. The protection for you must be sufficiently broad to protect you, all related parties including, but not limited to, your and their officers, directors, shareholders, employees, contractors, agents, representatives, broadcasters, writers, distributors, licensees, assigns, and all parties to whom you or they submit material or have been or may be involved in developing, financing or exploiting materials and properties generally. Therefore, all references to “you” shall include each and all of the foregoing related parties, pursuant to Paragraph 14 below. Accordingly, as a further inducement to you to examine the submitted material and to consider me as a Finalist, I represent, warrant and agree, as follows:

 

a.       I acknowledge that the submitted material is submitted voluntarily and not in confidence or in trust, and that no confidential or fiduciary relationship is intended or created between you and me by reason of such submission or otherwise. Nothing in this agreement, or the submission of the submitted material, shall be deemed to place you in any different position from any other member of the public with respect to the submitted material. Accordingly, any part of such material which could be freely used by any member of the public may be used by you without liability to me or any other party claiming from or through me. In addition, I agree to the terms and conditions of Producer’s (or its affiliate’s) privacy policy on the ShakeShock.com Website (as defined in the Application), and agree to be bound by the terms thereof.

 

b.      I understand and agree that your use of material similar to or identical with the submitted material or containing features or elements similar to or identical with those contained in the submitted material shall not obligate you to negotiate with me nor entitle me to any compensation or other entitlement if you determine that you have an independent legal right to use such other material (either because, e.g., such features or elements were not new or novel, or were not originated by me, or were or may hereafter be independently created by or submitted to you); provided your determination with respect to such independent legal right shall be subject to the provisions of Paragraph 6 below.

 

5.      I represent and warrant that I alone directed (as that term is commonly used in the motion picture and television industry) the Submission. I further represent and warrant that the description provided above is true and accurate and that I own the submitted material, free of any lien or encumbrance; that it is original with me and not based on any other material or source; that the use and exploitation thereof will not violate or infringe any third party rights; and that I have the right to submit and to offer such material to you without obligation to any third party. I further represent and warrant that I have obtained all necessary rights to grant you the right and/or to permit you to use the submitted material in connection with The ShakeShock.com Website or otherwise, in any and all media now known or hereafter devised, throughout the universe in perpetuity, and that I have all production, distribution and/or exploitation rights in and to the submitted material, including, without limitation, all rights to the likenesses, names, voices, biographical information and performances of any actors or other persons incorporated in the submitted material, any locations, any artwork, any logos or other intellectual property, and any and all other elements or content in the submitted material. I further represent that either (a) I have obtained all necessary rights to grant you the right and/or to permit you to use all music and scoring incorporated in the submitted material as set forth herein, or (b) that I have notified you that I have not obtained all necessary rights to grant you the right and/or permit you to use all music and scoring by (i) submitting a Mailed Submission (as defined in the Application) and (ii) checking “NO” when asked at the conclusion of the Application. I further represent and warrant that I am competent to agree to all of the provisions in this Agreement.

 

 

6.      I agree that no obligation of any kind is assumed by or may be implied against you (including, without limitation, any obligation to pay money) by reason of your receipt or potential or actual review of the submitted material or any discussions or negotiations I may have, except pursuant to an express written agreement which may hereafter be executed by you, on the one hand, and me, on the other hand. Without limiting the foregoing, I specifically acknowledge and agree that (a) I do not and will not under any circumstances have any so-called “idea submission” or similar claim against you, and (b) you are free to use (i.e., you will not owe me any money or other obligation for using) any portion of the submitted material.

 

7.      If there is any dispute arising out of this agreement, including the substance, validity, operation, or breach hereof (including, but not limited to: if you should determine that you have the independent legal right to use material which, in whole or part, is similar to or identical with the submitted material, without entering into a written agreement for compensation to me, and if you proceed to use the same and if I disagree with your determination), the dispute between us shall be determined solely by submitting such to arbitration in Los Angeles, California, before an arbiter mutually selected by the parties who is experienced in the field with respect to the use of material similar to the submitted material; or, if we cannot mutually agree, then such arbiter shall be selected in accordance with the Commercial Arbitration rules of the American Arbitration Association. The arbitration shall be controlled by the terms of this agreement, and any award favorable to me shall be limited to the fixing of compensation for your use of the submitted material, which shall bear a reasonable relation to compensation normally paid by you and by ShakeShock.com for similar material taking into account the relative stature of the owner or author of similar materials. Such award will provide for each party, respectively, to bear its own costs of arbitration and attorneys’ fees. The pendency of the arbitration, the proceedings, any evidence or other material, and the award shall be maintained and remain confidential, except that an award may be confirmed by a court of competent jurisdiction provided no award which has been fully satisfied within 14 days of its issuance may be so confirmed.

 

8.      I assume full responsibility for any loss of the submitted material for any reason including, but not limited to, whether it is destroyed in connection with my electronic submission, mailed submission or otherwise. You shall have no obligation to read or consider the submitted material or to return the submitted material to me.

 

9.      Except as otherwise provided in this agreement, I hereby release you to the maximum extent allowed by law of and from any and all claims, costs, demands and liabilities of every kind whatsoever, known or unknown, that may arise in relation to the submitted material or by reason of any claim now or hereafter made by or through me or on my behalf (even though I realize that such might be based on facts or circumstances not now known or suspected by me to exist, which if known or suspected, would have materially affected our decision to enter into this agreement) that you have used or appropriated the submitted material. Without limiting the foregoing, I further expressly waive and release all rights to seek and/or obtain injunctive or other equitable relief (including rescission hereof) against you, in connection with this agreement and any exploitation of the submitted material and in connection with any other material, whether or not in whole or part identical with or similar to the submitted material.

 

10.  I agree to indemnify you and hold you harmless from and against all liability, actions, claims, demands, losses or damages (including attorneys’ fees and punitive damages) caused by or arising out of your use of the submitted material in any manner permitted by me herein, or as a result of any breach or alleged breach of any of my representations or warranties herein, including, but not limited to, those set forth in Paragraph 5, above.

 

11.  I am not now, nor have been in the past, an employee or an independent contractor of Producer, ShakeShock.com, or any of their parents, subsidiaries or affiliates.

 

Nothing in the release or application process is intended to create an employment relationship between the participant and Producer, or ShakeShock.com, and participant agrees that by submitting an Application to be considered as a participant, no such employment relationship is created or implied.

 

12.  Should any provision of this agreement be void or unenforceable, such provision shall be deemed omitted, and this agreement with such provision omitted shall remain in full force and effect.

 

13.  This agreement is entire and shall be binding on the parties’ respective successors, assigns, licensees and all affiliated and related parties. No statements or representations have been made except those expressly stated in this agreement. This agreement may be modified only by subsequent written agreement. “I,” “me” and “my” refers to the party submitting the material to you.

 

14.  “You” and “your” refers to Producer, ShakeShock.com, and their respective parents, subsidiaries, successors, assigns, affiliates, licensees, and the respective owners, officers, directors, members, contractors, agents and employees of each of the foregoing. You may freely assign, in whole or in part, your rights hereunder.

 

15.  This agreement will be interpreted in accordance with the laws of the State of California applicable to agreements entered into and fully performed therein by residents of said State.

 

Very truly yours,

 

Signature: ______________________________

 

Date: _________________________________

 

Name (please type or print clearly):

 

____________________________________

 

Title of Short Dockey: _____________________________

 

Title of Classic Poem Short was based on: ________________________

 

 

PARENTAL CONSENT (if signatory is a minor)

If signatory is not a minor, ignore this box.

 

I represent and warrant that I am the parent(s) or legal guardian(s) of the minor whose name appears above. I acknowledge that I have read the foregoing Application, including the Application Rules and Requirements, Participant’s Application Information Sheet, and Submitted Materials Release (collectively, the “Agreement”) and am familiar with each and all of the terms contained therein, I am satisfied that the Agreement is fair and equitable, and I hereby give my express consent to its execution by my child/ward and will not revoke my consent at any time. I hereby fully and unconditionally guarantee the performance of my child's/ward’s obligations as set forth in the above Agreement.

 

 

____________________________________

Signature of Parent or Guardian

 

____________________________________

Date

 

____________________________________

Name (Please Print)

 

____________________________________

Relationship to minor

 

____________________________________

Phone

 

____________________________________

Address (Street)

 

____________________________________

 (City)                       (State)                        (Zip)

 

 

 

 

 

 

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