Fillable ADULT CONSENT RELEASE FOR PARTICIPATION (Ames Laboratory)

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ADULT CONSENT RELEASE FOR PARTICIPATION (Ames Laboratory)

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U.S. DEPARTMENT OF ENERGY OFFICE OF SCIENCE
2020 REGIONAL SCIENCE BOWL - AMES, IOWA AND NATIONAL SCIENCE BOWL
®
ADULT CONSENT RELEASE FOR PARTICIPATION
Coach Co-coach NSB Alumnus Regional Coordinator Other
School________________________________
To promote, evaluate, or otherwise describe the Regional and National Science Bowl programs and
activities, I give permission to the U.S. Department of Energy, and its agents or contractors, including
ORAU, to use in connection with any publication (including but not limited to brochures, booklets,
videotapes, reports, press releases, websites, social media, and exhibits) any image or recording in which I
appear; to use and cite any comment(s), verbal or written, made by me about the program; and to use my
name in connection with any publication and in such manner as determined by Ames Laboratory at Iowa State
University and the Department.
I hereby release and discharge the U.S. Department of Energy, United States Government, Ames
Laboratory, Iowa State University, the State of Iowa, and the Board of Regents-State of Iowa, their
officers, agents, servants, and employees, and persons, firms, or corporations contracting with, or acting
on behalf of, the Department of Energy or the United States Government, including ORAU, Ames
Laboratory, Iowa State University, the State of Iowa, and the Board of Regents-State of Iowa with respect
to all activities associated with the 2020 Department of Energy Office of Science Regional and/or
National Science Bowl
®
competitions, as well as their heirs, executors, administrators, successors, or
assigns, from any cause of action of any nature whatsoever arising from my participation as a coach,
regional coordinator, or volunteer in any and all activities associated with the 2020 Department of Energy
Office of Science Regional and/or National Science Bowl
®
competitions.
(Print Name)
Date
(Signature in Ink or via Adobe Entrust)
For National Science Bowl
®
Regional Competition Use - Please upload the completed form
to the team's registration page: https://apps.orau.gov/nsb-coach/Account
Non-coaches: Please email a pdf of the form to nsb@orise.orau.gov
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ADULT CONSENT RELEASE FOR PARTICIPATION (Ames Laboratory)

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Completed 19 July 2020

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