Author: Calla
Last saved by: Calla Mae McCulley
Company: UAB

PHOTO and VIDEO RELEASE

I, ___________________________________________ (print name of legal guardian) on behalf of my child, ____________________________________ (print child name)

choose to allow my child to be photographed/videoed

do not want my child to be photographed/videoed

at the event entitled Mad Scientist Day on May 16^th 2015 hosted by SAACS at UAB. (Please check one box). I realize that these photos and videos may be used in advertisements for future events or in record of the event itself in manners that may be seen by the public (news releases, SAACS website, organizational reports…etc.).

Signature of Legal Guardian __________________________________________

Date ________________________

Signature of SAACS Officer ___________________________________________

Date ________________________