Doodle title:

Doodle description - 50 words max

Google D4GXD4G3RXD4G

School Name:

Student Name:

School address:

Student Age:

Town:

Student Class or Year:

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 Ireland 2016 Contest. I have read and accept the Official Doodle 4 Google Contest rules located at google.ie/doodle4google/rules.html and acknowledge that Google's Privacy Policy located at google.ie/privacy applies.

County: Teacher Name: School phone number:

Teacher email:

Parent / Guardian Signature