Doodle title:

Doodle description - 50 words max

Google D4GXD4G3RXD4G

Parent/Guardian
Name:

Student Name:

Address:

Student Grade:

City, State, Zip Code:

School Name:

Email:

School Address inc.

City, State, Zip Code:

Phone:

School Phone:

By signing below, I acknowledge that I am a parent/legal guardian of the entrant

and hereby give my permission for him/her to enter Doodle 4 Google 2015
Contest. I have read and accept the Official Doodle 4 Google Contest rules
located at google.com/doodle4google/rules.html and acknowledge that
Googles Privacy Policy located at google.com/privacy applies. I confirm that
the Entrant is: (a) a U.S. citizen or permanent U.S. legal resident (b) enrolled
in a private or public elementary or secondary school (grades K12) or a home
school (grades K-12) in the United States, Puerto Rico or Guam.

Parent / Guardian Signature: