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U.S. DEPARTMENT OF ENERGY OFFICE OF SCIENCE
2020 REGIONAL SCIENCE BOWL - AMES IOWA AND NATIONAL SCIENCE BOWL
®
PARENTAL CONSENT / MEDIA RELEASE FOR STUDENT PARTICIPATION
School______________________________________
I, (Mr., Mrs., Ms.) ________________________________________________, the parent or legal guardian, as
appropriate, of _____________________________________, give my consent for him/her to participate in all
activities associated with the 2020 U.S. Department of Energy Office of Science Regional and/or National
Science Bowl
®
competitions.
I understand that this will include participation in special events and activities related to the 2020 Department of
Energy Office of Science Regional and/or National Science Bowl
®
competitions, and will include travel under the
supervision of the team coach.
To promote, evaluate, or otherwise describe the Regional or National Science Bowl programs and activities, I give
permission to the Department of Energy, and its agents or contractors, including ORAU, to use in
connection with any publication (including but not limited to brochures, booklets, videos, reports, press
releases, websites, including social media, and exhibits) any image or recording in which my child, a minor,
appears, to use and cite any comment(s), verbal or written, made by said minor about the program, and to use
said minor’s 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 Department of Energy, the 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, 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 child’s participation in any and all activities associated with the 2020 Department of Energy Office of
Science Regional and/or National Science Bowl
®
competitions.
(Print Name of Parent or Legal Guardian)
Date
(Signature of Parent or Legal Guardian in Ink)
NOTE: Team members 18 or older may sign this form.
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
click to sign
signature
click to edit
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