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 Google’s 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: