Student Award Ceremony Template

Student Award Ceremony Template

Event Information

Event Name:    Date:

Student Information

Date of Birth:    Student ID:

Parent / Guardian (if student is a minor)

Relationship to Student:    Phone:

Award Details

Academic Excellence    Leadership    Community Service

Arts / Performance    Athletics    Other:

Attendance & Logistics

Attendance Confirmation: I/We will attend the ceremony    Number of Guests:

Expected Arrival Time:

Media Release & Publicity Consent

By checking the box below, the signer grants the school and its agents the right to photograph, record, and publish the student's name, image, and statements in connection with publicity for the award ceremony. This consent is perpetual and may be used for promotional, archival, and educational purposes. Consent is given without payment or other compensation.

I consent to use of the student's likeness and statements as described above

Emergency & Medical Information

Emergency Contact Phone:    Relationship:

I authorize emergency medical treatment for the student if necessary and agree to be financially responsible for such care if not covered by institutional policies.

Award Acceptance & Conditions

The recipient acknowledges that acceptance of the award requires attendance at the ceremony unless prior written exception is granted by the organizing committee. Failure to attend without prior notice may result in forfeiture or reassignment of the award. Certain awards may be subject to additional terms, including recognition events, media appearances, or reporting requirements; these will be communicated in writing where applicable.

I have read and agree to the award conditions and understand that the award may be rescinded for violation of school policies or code of conduct.

I acknowledge that certain awards may have tax or reporting implications and agree to provide requested information for administrative compliance if required.

Policy Acknowledgment

By signing below, the signer affirms that the student has complied with applicable eligibility criteria and all information provided on this form is true and complete to the best of the signer's knowledge. The signer further acknowledges the student's obligation to adhere to the school code of conduct during the award ceremony and related events.

I affirm that the statements herein are accurate and that I understand and accept the policies described.

Additional Notes

Certification and Signature

Certification: I certify under penalty of perjury that I am authorized to submit this form on behalf of the student named above. I understand that this form will be retained in school records and used for event coordination and administrative purposes.

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