Model Release Form

Students over the age of 18 may sign for themselves; students under 18 must have this release signed by their parent or guardian.

I hereby consent to the use of this photograph or video of my child/dependent/self, and/or any copies of this photograph or video in any editorial and/or promotional material produced and/or published by the National Science Teaching Association.

I understand that signing this release does not guarantee publication of the photo.

Name of student in the photo or video

_____________________________________________

Name (Adult or Parent/Guardian)

_____________________________________________

Signature (Adult or Parent/Guardian)

_____________________________________________

Date: _______________