Thank you for being part of the 2020-2021 Future City Program! This form must be completed by the parent or guardian of each student prior to the Regional Competition and Finals Competition.

By inserting/typing my name in the electronic signature section below, I hereby give my consent to DiscoverE, DoGoodery, Future City and any of its official sponsors or affiliates to use the student's name, photograph, and likeness in order to promote the Future City® Competition at the Regional and Finals (if applicable) competition levels. I understand that the student may be called upon by journalists to answer questions about their involvement in the Future City® Competition, and I will allow them to speak to any media via phone or television. I also hereby certify that the signature that appears below is my signature, is the person identified by that signature, and that any misrepresentation or signature falsification by any person will result in the immediate and permanent disqualification of that person from all current and future National Engineers Week Foundation, DiscoverE and Future City programs and activities.

School Name/Educator:
Student Name: First: Last:
Student Age:
Guardian Name: First: Last:
Guardian eMail:
Guardian Cell Phone:
Zip/Postal Code:
Date: 03/08/2021


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