Parental consent

I, the undersigned, Mr. / Ms. .....................................................................................................

in my capacity as
 Mother
 Father
 Legal Guardian
Certify that I have parental responsibility for ………………………………………………...
(hereafter the “Minor”) and hereby give my consent for him / her to:

 By checking this box, you confirm that you allow the Minor to take part in a student
Challenge, giving him / her access to 3DS software and applications.
 (Optional) By checking this box, you confirm that you give Dassault Systèmes SE, whose
headquarters are located at 10, rue Marcel Dassault, 78140 Vélizy-Villacoublay, France, and
all of its affiliated entities (hereafter “3DS”) the right and permission to use, free of charge, the
Minor’s image, and his / her first name and last name for the purposes of internal and/or external
communications, promotion and/or marketing under the following conditions :
a. on any communication medium, in particular printed, audiovisual, digital,
electronic, existing (press, internet, posters, etc.) or future ones;
b. in any format;
c. worldwide;
d. for a period of five (5) years following the beginning date of the Challenge;
e. in respect of any form of communication to the public, of various kinds (for
example, for the purpose of promoting the 3D’s brands, products and
activities, as part of any advertising and promotional action or event, etc.)

I waive any right to examine or approve the actions carried out by 3DS in accordance with
this consent and release 3DS from all claims, demands and causes of action that I or any other
person acting in my name have or could have in connection with this consent.

Signed in ……………………………………….……………. [place]

Date:
Signature:

This consent form should be signed and returned using this online form (https://3ds-upl-
pa.paperform.co/).