STEAM Summer Academy

Child's Information:

Parent/Guardian Information:

Emergency Information:

Health Information:

Attendance Release:
I have filled out this form to the best of my ability and approve of my child's attendance in the STEAM Academy

Release for Media Recording:
I, the undersigned, do hereby consent and agree that the University of San Diego, its employees, or agents have the right to take my daughter’s/son’s photographs, videotape, or digital recordings to use any and all media, now or hereafter, including composite or partial representations, for recruitment, advertising, instruction, or any other lawful purpose; and I waive any right to inspect or approve the finished product, including written copy that may be created in connection therewith.  However, no names will be used to identify persons in media without expressed permission.  I understand that there will be no financial or other remuneration for photographing or videotaping my daughter.

I also understand that the University of San Diego is not responsible for any expense or liability incurred as a result of my daughter’s participation in this recording, including medical expenses due to any sickness or injury incurred as a result.