Please print, fill out, scan and email this form to NASADebates@gmail.com.
Please put the name of the student for whom you are submitting the form in the subject line of your email.
The student's registration will not be processed without receipt of this Parent/Guardian Consent Form.
This section is to be completed and signed by a Parent or Guardian. If the student is 18 years of age or over they should complete and sign the form themselves.
NASA Astrobiology Debates Parent/GuardianConsent Form
I authorize my child (Full Name of Child), __________________________________ to participate in the NASA Astrobiology Speech Competition. He/She attends _____________________ (school). I certify that he/she is in _____ grade and was born on __________ (month) __________ (day), __________ (year). I hereby release NASA and/or George Washington University and their respective member companies, affiliates, Board of Governors/Trustees, officers, employees, licensees and assigns from all claims, demands, liabilities, damages, costs and expenses that I may now or hereafter have against NASA and/or The George Washington University arising in connection with student’s participation in the NASA Astrobiology Speech Competition.
I hereby grant to NASA and/or The George Washington University and their respective member companies, affiliates, Board of Governors/Trustees, licensees and assigns the right to photograph and/or videotape and use the videotape and/or photograph of the below named student during participation in any events related to the NASA Astrobiology Speech Competition and the right to use this media without further compensation to me or student or any limitation whatsoever. Parent/Guardian Name: ____________________________________________________________
Signature: ________________________________________________________________________ Email: ___________________________________________________________________________ Address 1: ________________________________________________________________________ Address 2: ________________________________________________________________________ City: _____________________ State: ________________________
Zip: _____________________ Phone (day):____________________
Phone (evening):______________________ Phone (mobile): _________________