I, the undersigned, as: father / mother / legal guardian
Last name First Name : ………………………………………………………………………………..
Address : …………………………………………………………………………………………………… ………………..
ZIP code : …………………………………………………………………………………………..
Phone: …………………… Email:………………………………………………………………………………..
Holder of parental authority over the person of: (below, the “Minor”)
Last name First Name : ………………………………………………………………………………..
Date and place of birth: ………………….……………………….. Age: ………………… …………………
– Authorizes the minor to participate in the National Drawing and Painting Competition for the visually impaired organized by “Art and LowVision”;
– Declares having read and accepted the provisions of the competition rules, in particular those set out in article 22 on copyright;
– Authorizes “Art and LowVision”, in accordance with the aforementioned regulations and general conditions of use, to disseminate the name of the Minor;
– Declares to be personally responsible for the acts committed by the Participating Minor in the context of his participation in the National Drawing and Painting Competition for the visually impaired;
– Declares that the information mentioned above is accurate and complete.
Made in ………………………………. The ……………………………………
Signature