WBEB 101. More FM Christmas Choir Competition 2018 Contest Rules

Transcription

1 WBEB 101. More FM Christmas Choir Competition 2018 Contest Rules These Contest rules are specific to the above Contest conducted by Entercom Pennsylvania, LLC d/b/a WBEB (the Station ). Except to the extent specifically set forth below with respect to this specific Contest, the Station s general contest rules apply to this Contest as well. A copy of these specific Contest rules and the Station s general contest rules are available at the Station s studio at 555 City Ave., Suite 330 Bala Cynwyd, PA during regular business hours and on the Station s website at To the extent that the general contest rules differ from these rules, these rules will govern and control with respect to this Contest. How to Enter 1. No Purchase Necessary to enter or win the WBEB 101. More FM Christmas Choir Competition (the Contest ). 2. Elementary schools, middle schools, and high schools (grades K-12) wishing to participate may be public or private, but must be located in one the following counties in Pennsylvania: Bucks, Chester, Delaware, Montgomery and Philadelphia counties and in New Jersey: Burlington, Camden, Gloucester counties. 3. For the purposes of this Contest, a Choir/Band is defined as a group containing performers who must be elementary school, middle school, or high school students in grades kindergarten through twelve (12). 4. One (1) entry per Choir/Band director and Choir/Band only (each an Entry and collectively Entries ). Elementary schools, middle schools, and high schools that have multiple Choirs/Bands based on grade level, size, etc., may submit multiple Entries provided that no person performs in more than one Entry. Each Entry must be submitted as a separate mp3, mp4, or wav. Submissions will be placed in either Division I (Kindergarten 8th grade) or Division II (9th grade 12th grade) (each, a Division ). Only one (1) choir from an individual school can advance to the Semi-Finals of the competition, regardless of division submitted. All submissions must include students from the current school year. Entry deadline is November 16, 2018 at 5:00pm (ET). 5. From approximately 12:01am (ET) on Monday, October 15, 2018 until 5:00pm (ET) on Friday, November 16, 2018, elementary school, middle school, or high school Choir/Band directors (hereafter referred to as a Representative or an Entrant ) may enter this Contest by submitting an mp3, mp4, or wav vocal/instrumental performance of a holiday song (the Performance ), as follows: i. Visit the Contests page on the Station website at click the graphical Christmas Choir Competition link, and complete the online submission form as follows: 1. Enter your address; 2. Complete the online submission form with the name of the Entrant, the Entrant s home address and daytime telephone number, the name of the High School where Entrant is a Choir/Band director, the Choir/Band name, and the physical address of the school; and 3. Upload an audio file in the mp3, mp4, or wav file format ONLY of the Performance. (NOTE: THIS DOES NOT COMPLETE THE ENTRY PROCESS). 4. Entrants who successfully submit all of the required information above will receive an confirmation, sent to the address provided by Entrant when completing the online submission form, within approximately twenty-four (24) hours that will include a link to access and download the REQUIRED Consent to Participation form (also available as Attachment A to these rules). ii. Entrants MUST print and complete the Consent to Participation form (accessible either by link provided in submission confirmation or as Attachment A to these rules), AND then submit the completed form to the Station either by to webmaster@morefmphilly.com or by dropping off at the Station BY NO LATER THAN 5:30pm (ET) on Monday, November 19, ETM:102226_2.DOCX 1

2 iii. ENTRANTS WHO DO NOT COMPLETE AND SUBMIT A COMPLETED CONSENT TO PARTICIPATION FORM BY 5:30pm (ET) ON MONDAY, NOVEMBER 19, 2018 WILL BE DISQUALIFIED. 6. The Representative submitting the Entry is responsible for obtaining written permission from ALL performers (or from a parent or legal guardian if the performer is under 18 years of age), consenting to submission of the Entry and participation in the Contest and must sign a certification ( Certification ) to this effect in the form attached to these Contest rules as Attachment A and submit it with their Entry. Representatives must be employees, not students, of the middle school or high school for which they are submitting an Entry, and 18 years of age or older. FAILURE TO SUBMIT ALL ITEMS AS REQUIRED WILL RESULT IN IMMEDIATE DISQUALIFICATION. 7. By entering this Contest, Entrants represent warrant and covenant that they have obtained permission from all performers (or from a parent or legal guardian if the performer is under 18 years of age), consenting to submission of the Entry, participation in the Contest and agreement to the terms of these official Contest rules. 8. By entering this Contest, Entrants understand and agree that Station may elect to use any Entry submitted for entertainment purposes on-air and may choose to make fun of any entry submitted. Entrants waive any right to make any claim against Station, Choir/Band, or any Contest sponsors with respect to any disparaging comment made on-air about such entrant s entry. 9. By entering this Contest, Entrants and associated middle schools and high schools which Entrant represents agrees to indemnify, defend and hold Station harmless from and against any claims, expenses proceedings, suits, actions or costs (including costs from reasonable attorneys fees) of any kind or nature incurred by Station on account of a breach by Entrant of any of their representations, warranties, covenants or agreements as a result of Entrant s participation in the Contest. How to Win 10. At approximately 12:00 pm (ET) on November 20, 2018 Station staff and/or management ( Station Judges ) will review all eligible Entries submitted and select up to nine (9) entries per Division (i.e. nine (9) entries for Division I and nine (9) entries for Division II) based upon any lawful criteria as determined by the Station Judges in their sole discretion, to continue in the Contest as set forth in Sections below, subject to verification of Contest eligibility and compliance with these Contest rules (each, a Semi-Finalist ). 11. Division I (Kindergarten 8th grade)- One (1) 1 st Place Prize Winner one (1) 2 nd Place Prize Winner will be selected, and one (1) 3 rd Place Prize Winner will each be selected from among the nine (9) Division I Semi-Finalists as follows: a. Division I Semi-Finals (Monday, November 26, 2018 Wednesday, November 28, 2018) i. On Monday, November 26, 2018, three (3) Semi-Finalists will be randomly selected from among all nine (9) Division I Semi-Finalists to be showcased and have their entries played on-air on the Station (in no particular order) between 6:00am (ET) and 7:00am (ET). After the last Semi-Finalist s entry has aired on the Station on Monday, November 26, 2018, the three (3) Semi-Finalists whose entries were aired on Monday, November 26, 2018 will have their school names posted on the Station s website at for listener voting until 9:00pm (ET) on Monday, November 26, There is no limit on the number of votes per listener. After 9:00pm (ET) on Monday, November 26, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Semi-Finalist receives, one (1) Semi- Finalist from among the (3) Semi-Finalists showcased that same day, to continue in the Contest as a Division I Finalist. On Tuesday, November 27, 2018 at approximately 7:00 am (ET), the Station will announce the selected Division I Finalist from the previous day. Such Division I Finalist need not be listening at the time of such announcement in order to advance in this Contest. The Station will announce the Finalist on-air on ETM:102226_2.DOCX 2

3 Tuesday, November 27, 2018 and will also notify the Representative for each Choir via telephone. ii. On Tuesday, November 27, 2018, three (3) Semi-Finalists will be randomly selected from among the remaining six (6) Division I Semi-Finalists to be showcased and have their entries played on-air on the Station (in no particular order) between 6:00am (ET) and 7:00am (ET). After the last Semi-Finalist s entry has aired on the Station on Tuesday, November 27, 2018, the three (3) Semi-Finalists whose entries were aired on Tuesday, November 27, 2018 will have their school names posted on the Station s website at for listener voting until 9:00pm (ET) on Tuesday, November 27, There is no limit on the number of votes per listener. After 9:00pm (ET) on Tuesday, November 27, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Semi-Finalist receives, one (1) Semi- Finalist from among the (3) Semi-Finalists showcased that same day, to continue in the Contest as a Division I Finalist. On Wednesday, November 28, 2018 at approximately 7:15 am (ET), the Station will announce the selected Division I Finalist from the previous day. Such Division I Finalist need not be listening at the time of such announcement in order to advance in this Contest. The Station will announce the Finalist on-air on Wednesday, November 28, 2018 and will also notify the Representative for each Choir via telephone. iii. On Wednesday, November 28, 2018, the remaining three (3) Semi-Finalists will be showcased and have their entries played on-air on the Station (in no particular order) between 6:00am (ET) and 7:00am (ET). After the last Semi-Finalist s entry has aired on the Station on Wednesday, November 28, 2018, the three (3) Semi-Finalists whose entries were aired on Wednesday, November 28, 2018 will have their school names posted on the Station s website at for listener voting until 9:00pm (ET) on Wednesday, November 28, There is no limit on the number of votes per listener. After 9:00pm (ET) on Wednesday, November 28, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Semi-Finalist receives, one (1) Semi-Finalist from among the (3) Semi-Finalists showcased that same day, to continue in the Contest as a Division I Finalist. On Thursday, November 29, 2018 at approximately 7:00am (ET), the Station will announce the selected Division I Finalist from the previous day. Such Division I Finalist need not be listening at the time of such announcement in order to advance in this Contest. The Station will announce the Finalist on-air on Thursday, November 29, 2018 and will also notify the Representative for each Choir via telephone. b. Division I Finals (Thursday, November 29, Friday, November 30, 2018) i. On Thursday, November 29, 2018, the three (3) Division I Finalists will be showcased and have their entries played on-air on the Station (in no particular order) between the hours of 6 am (ET) and 7:00am (ET). After the last Finalist s entry has aired on the Station on Thursday, November 29, 2018, the three (3) Finalists will have their school names posted on the Station s website at for listener voting until 9:00pm (ET) on Thursday, November 29, There is no limit on the number of votes per listener. After 9:00pm on Thursday, November 29, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Division I Finalist receives, (i) one (1) Division I Finalist from among the (3) Finalists showcased that same day as the Division I 1 st Place Winner to receive the Division I 1 st Place Prize as set forth in Section 14 below; (ii) one (1) Division I Finalist from the remaining two as the Division I 2 nd Place Winner to receive the Division I 2 nd Place Prize as set forth in Section 15 below; and (iii) deem the remaining Division I Finalist as the Division I 3 rd Place Winner to receive the Division I 3 rd Place Prize as set forth in Section 16 below. On Friday, November 30, 2018 at approximately 7:00am (ET), the Station will announce the selected the Division I 1 st Place Prize Winner, the Division I 2 nd Place Prize winner, and the Division I 3 rd Place Prize Winner. Winners need not be listening at the time of such announcement in order to win. The Station will also notify the Representative for each Choir via telephone. ETM:102226_2.DOCX 3

4 12. Division II (9th 12th grade) One (1) 1 st Place Prize Winner will be selected, one (1) 2 nd Place Prize Winner will be selected, and one (1) 3 rd Place Prize Winner will be selected as follows: a. Division II Semi-Finals (Monday, December 3, 2018 Wednesday, December 5, 2018) i. On Monday, December 3, 2018, three (3) Semi-Finalists will be randomly selected from among all nine (9) Division II Semi-Finalists to be showcased and have their entries played on-air on the Station (in no particular order) between 6:00am (ET) and 7:15am (ET). After the last Semi-Finalist s entry has aired on the Station on Monday, December 3, 2018, the three (3) Semi-Finalists whose entries were aired on Monday, December 3, 2018 will have their school names posted on the Station s website at 7:00am for listener voting until 9:00pm (ET) on Monday, December 3, There is no limit on the number of votes per listener. After 9:00pm (ET) on Monday, December 3, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Semi-Finalist receives, one (1) Semi-Finalist from among the (3) Semi-Finalists showcased that same day, to continue in the Contest as a Division II Finalist. On Tuesday, December 4, 2018 at approximately 7:00am (ET), the Station will announce the selected Division II Finalist from the previous day. Such Division II Finalist need not be listening at the time of such announcement in order to advance in this Contest. The Station will announce the Finalist on-air on Tuesday, December 4, 2018 and will also notify the Representative for each Choir via telephone. ii. On Tuesday, December 4, 2018, three (3) Semi-Finalists will be randomly selected from among the remaining six (6) Division II Semi-Finalists to be showcased and have their entries played on-air on the Station (in no particular order) between 6:00am (ET) and 7:00am (ET). After the last Semi-Finalist s entry has aired on the Station on Tuesday, December 4, 2018, the three (3) Semi-Finalists whose entries were aired on Tuesday, December 4, 2018 will have their school names posted on the Station s website at for listener voting until 9:00pm (ET) on Tuesday, December 4, There is no limit on the number of votes per listener. After 9:00pm (ET) on Tuesday, December 4, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Semi-Finalist receives, one (1) Semi- Finalist from among the (3) Semi-Finalists showcased that same day, to continue in the Contest as a Division II Finalist. On Wednesday, December 5, 2018 at approximately 7:00am (ET), the Station will announce the selected Division II Finalist from the previous day. Such Division II Finalist need not be listening at the time of such announcement in order to advance in this Contest. The Station will announce the Finalist on-air on Wednesday, December 5, 2018 and will also notify the Representative for each Choir via telephone. iii. On Wednesday, December 5, 2018, the remaining three (3) Semi-Finalists will be showcased and have their entries played on-air on the Station (in no particular order) between 6:00am (ET) and 7:00am (ET). After the last Semi-Finalist s entry has aired on the Station on Wednesday, December 5, 2018, the three (3) Semi-Finalists whose entries were aired on Wednesday, December 5, 2018 will have their school names posted on the Station s website at for listener voting until 9:00pm (ET) on Wednesday, December 5, There is no limit on the number of votes per listener. After 9:00pm (ET) on Wednesday, December 5, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Semi-Finalist receives, one (1) Semi-Finalist from among the (3) Semi-Finalists showcased that same day, to continue in the Contest as a Division II Finalist. On Thursday, December 6, 2018 at approximately 7:00am (ET), the Station will announce the selected Division II Finalist from the previous day. Such Division II Finalist need not be listening at the time of such announcement in order to advance in this Contest. The Station will announce the Finalist on-air on Thursday, December 6, 2018 and will also notify the Representative for each Choir via telephone. b. Division II Finals (Thursday, December 6, Friday, December 7, 2018) ii. On Thursday, December 6, 2018, the three (3) Division II Finalists will be showcased and have their entries played on-air on the Station (in no particular order) between ETM:102226_2.DOCX 4

5 the hours of 6:00am (ET) and 7:00am (ET). After the last Finalist s entry has aired on the Station on Thursday, December 6, 2018, the three (3) Finalists will have their school names posted on the Station s website at for listener voting until 9:00pm (ET) on Thursday, December 6, There is no limit on the number of votes per listener. After 9:00pm (ET) on Thursday, December 6, 2018, Station Judges will select, based upon any lawful criteria including the total number of listener votes each Division II Finalist receives, (i) one (1) Division II Finalist from among the (3) Finalists showcased that same day as the Division II 1 st Place Winner to receive the Division II 1 st Place Prize as set forth in Section 17 below; (ii) one (1) Division II Finalist from the remaining two as the Division II 2 nd Place Winner to receive the Division II 2 nd Place Prize as set forth in Section 18 below; and (iii) deem the remaining Division II Finalist as the Division II 3 rd Place Winner to receive the Division II 3 rd Place Prize as set forth in Section 19 below. On Friday, December 7, 2018 at approximately 7:00am (ET), the Station will announce the selected the Division II 1 st Place Prize Winner, the Division II 2 nd Place Prize winner, and the Division II 3 rd Place Prize Winner. Winners need not be listening at the time of such announcement in order to win. The Station will also notify the Representative for each Choir via telephone. 13. LISTENER VOTING WILL NOT BE THE SOLE DETERMINING FACTOR IN THE OUTCOME OF ANY ROUND OF THIS CONTEST AS SET FORTH ABOVE, BUT STATION JUDGES MAY TAKE THE NUMBER OF VOTES EACH SEMI-FINALIST OR FINALIST, AS APPLICABLE, RECEIVES AS ONE OF MANY FACTORS THE STATION JUDGES CONSIDER IN DETERMINING WHICH SUCH SEMI-FINALISTS OR FINALISTS, AS APPLICABLE, CONTINUE IN AND/OR WIN, AS APPLICABLE, THIS CONTEST. Prize(s) 14. One (1) Division I 1 st Place Prize will be awarded in the Contest. The Division I 1 st Place Prize includes the following: (i) $5, awarded to the winning school; (ii) the opportunity for the Choir to perform their winning song with The Philly Pops at the Kimmel Center on December 5, 2018 at the Kimmel Center 300 S Broad St, Philadelphia, PA 19102; and (iii) up to fifty (50) tickets to The Philly Pops performance on December 5, 2018 (tickets are for up to fifty-eight (58) Choir members and eight (8) chaperones and choir directors. Choir members singing are limited to up to fifty (50) students for safety reasons. Each school is responsible for selecting the fifty (50) students. NOTE: If the Division I 1 st Place Prize winning school is unable to perform at the Kimmel Center on December 5, 2018, it will not disqualify the school from competition, and they are still eligible to win the $5000 part of the prize, however they will forfeit the opportunity to perform on December 5, 2018 as well as the tickets to the December 5, 2018 Philly Pops performance. The Station may, but is not obligated, to allow the Division I 2 nd Place Prize Winner) to perform instead on December 5, 2018 and win the tickets to the December 5, 2018 performance. Prizes will be awarded in the form of a corporate check made payable to the winning school s Choir/Band program. Employee/Representative who submitted the Entry of the winning school s Choir/Band will forfeit any prize or prize certificate not claimed within seven (7) days of winning, and on behalf of the school, will be required to submit all required paperwork and provide all Station-requested information for the check to be issued. Checks may take up to twelve (12) weeks to receive and will be mailed directly to the winning school s Choir/Band program. 15. One (1) Division I 2 nd Place Prize will be awarded in the Contest. The Division I 2 nd Place Prize is $2, One (1) Division I 3 rd Place Prize will be awarded in the Contest. The Division I 3 rd Place Prize is $1, One (1) Division II 1 st Place Prize will be awarded in the Contest. The Division II 1 st Place Prize includes the following: (i) $5, awarded to the winning school; (ii) the opportunity for the Choir to perform their winning song with The Philly Pops at the Kimmel Center on December 12, 2018 at the Kimmel Center 300 S Broad St, Philadelphia, PA 19102; and (iii) up to fifty-eight (58) tickets to ETM:102226_2.DOCX 5

6 The Philly Pops performance on December 12, 2018 (tickets are for up to fifty (50) Choir members and eight (8) chaperones and choir directors. Choir members singing are limited to up to fifty (50) students for safety reasons. Each school is responsible for selecting the fifty (50) students. NOTE: If the Division II 1 st Place Prize winning school is unable to perform at the Kimmel Center on December 5, 2018, it will not disqualify the school from competition, and they are still eligible to win the $5000 part of the prize, however they will forfeit the opportunity to perform on December 12, 2018 as well as the tickets to the December 12, 2018 Philly Pops performance. The Station may, but is not obligated, to allow the Division II 2 nd Place Prize Winner) to perform instead on December 12, 2018 and win the tickets to the December 12, 2018 performance. Prizes will be awarded in the form of a corporate check made payable to the winning school s Choir/Band program. Employee/Representative who submitted the Entry of the winning school s Choir/Band will forfeit any prize or prize certificate not claimed within seven (7) days of winning, and on behalf of the school, will be required to submit all required paperwork and provide all Station-requested information for the check to be issued. Checks may take up to twelve (12) weeks to receive and will be mailed directly to the winning school s Choir/Band program. 18. One (1) Division II 2 nd Place Prize will be awarded in the Contest. The Division II 2 nd Place Prize is $2, One (1) Division II 3 rd Place Prize will be awarded in the Contest. The Division II 3 rd Place Prize is $1, Division I and Division II 1 st Place Prize winning Choirs will need to arrive at least one (1) hour prior to the show and will be taken to a special staging area until their time to perform. School Choir directors must meet with The Philly Pops for a walk-through at the Kimmel Center prior to the performance date. School Choirs are invited to sing in the atrium of the Kimmel Center prior to their performance. Choirs will be asked to sing songs other than the song they are performing on stage. The Choirs are not permitted to bring in any outside food or beverages. Choirs are expected to dress in a uniform manner, or in black pants/skirts and white shirts. Schools must provide adult chaperones at a rate of 5:1. The Philly Pops will also offer ticket availability for each school of up to one-hundred and fifty (150) tickets on designed show dates for purchase by choir students family members. These tickets may or may not include a special discount. Parents must supply appropriate validation code to order tickets. Sponsors 21. Sponsors of this Contest are: Pandora Jewelers and Entercom Philadelphia, LLC d/b/a WBEB. Other Rules Specific to This Contest 22. Station retains sole and exclusive possession and retains all rights to use any performance Entry, or any part thereof, indefinitely in any promotions including but not limited to on-air usage without any compensation to Entrants or any third parties. The aforementioned stipulations apply to all winning and non-winning Entries. Station is not responsible for any costs associated with submitting any Entry or any costs arising out of participating in the Contest or failure to adhere to official Contest rules. 23. Station is not responsible for technical problems that may impact the ability of mp3, mp4, or wav entries to properly download and play on Station computer. ETM:102226_2.DOCX 6

7 ATTACHMENT A WBEB 101. More FM Christmas Choir Competition ( CONTEST ) CERTIFICATION OF CONSENT TO PARTICIPATION This CERTIFICATION must be signed below by the Representative responsible for submitting an entry in this Contest. All references below to I, my and me and Entrant refers to the Representative who signs the form below. By signing below, I, the undersigned, certify that I have obtained written permission from ALL performers (or from a parent or legal guardian if the performer is under 18 years of age) who performed on the mp3, mp4, or wav (the Content ) I submitted as entry into this Contest and that each performer (or parent or legal guardian if the performer is under 18 years of age) consented to submission of the Entry and participation in the Contest. I also acknowledge that the rules associated with this Contest are available to me at I agree that by being permitted to participate I agree to be bound by the terms and conditions of all rules applicable to this Contest. By entering this Contest and submitting an entry, I represent to the Station that the use and distribution of such entry will not violate or infringe upon the rights of any third party, including, without limitation, copyrights of others. By entering this Contest, I understand and agree that Station may elect to use any Entry submitted for entertainment purposes on-air or online. I waive, and have secured from all members of the Choir/Band, any right to make any claim against Station or any Contest sponsors with respect to any disparaging comment made about such Entrant s entry. I hereby irrevocably grant to Entercom, and represent that I have secured from all members of the Choir/Band to grant on their behalf to Entercom, a perpetual, transferable, royalty-free license to use, publish, broadcast, transmit, and exploit the name, likeness, portrait, recorded voice and/or image and likeness of myself and all members of the Choir/Band, in any manner, by any means, whether now known or hereafter devised, as well as the right to edit, alter, or otherwise use the Content in whole or in part, alone or in compilation with content provided by third parties, and for any of which neither I nor any member of the Choir/Band shall receive any payment or any additional compensation; and in so doing, I respectively waive, and have secured from all members of the Choir/Band the right to waive, any potential claims against Entercom or any of its affiliates with respect to any such usage and/or editing in whole, or in part, alone or in compilation with content provided by third parties. Specifically, I acknowledge and agree, and have obtained from all members of the Choir/Band their acknowledgement and agreement, that such Content may be used by Entercom for, among other things, and without limitation, posting on the internet (including without limitation, the Station website(s) and third party websites such as Facebook or Twitter, Instagram, or YouTube, and/or social media pages, and/or viral distribution through or other means of sharing), inclusion in commercials however distributed, and/or for on-air broadcast or other cable, fiber, satellite, mobile or other means of distribution, and I hereby consent, and have secured from all members of the Choir/Band their consent, to all such use, for any of which neither I nor any member of the Choir/Band shall receive any payment or any additional compensation. By entering this Contest, Entrants and associated elementary school, middle school, or high school which Entrant represents agrees to indemnify, defend and hold Station from and against any claims, expenses proceedings, suits, actions or costs (including costs from reasonable attorneys fees) of any kind or nature incurred by Station on account of a breach by Entrant of any of their representations, warranties, covenants or agreements as a result of Entrant s participation in the Contest. I have read this certification and fully understand its contents. I acknowledge that this certification was willingly and voluntarily signed. I affirm that I am more than 18 years of age and that I intend to be legally bound by the terms of this certification. ETM:102226_2.DOCX 7

8 I agree to keep the original copies of the written consents described above for at least 6 months after this Contest ends and to provide it to Entercom Pennsylvania, LLC ( Entercom ), upon Entercom s request, at any time prior to six (6) months after this Contest ends whether or not I am a winner in this Contest. AGREED TO BY: Print Name Signature Date School Street Address City / State / Zip Code Phone Number ETM:102226_2.DOCX 8