7/27/2019 AIU Waiver and Photo Release

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ALLEGHENY INTERMEDIATE UNITAPPRENTICESHIP PROGRAM

STUDENT PARTICIPANT -- RELEASE AND WAIVERThe undersigned, while participating in the Allegheny Intermediate Unit Gifted & Talented Education

Apprenticeship Program, agrees to abide by all rules and safety requirements for the site to be visited, and

assumes all risks arising from or related to his or her participating in the program. The undersigned, andany parent or guardian, if a minor, hereby waives and releases the Allegheny Intermediate Unit from any

and all claims and causes of action against the aforementioned for any damage or injury to the person or

property of the undersigned, or parent or guardian, alleged to have been caused by any act.

This release and waiver shall apply at all times that the undersigned is away from his or her residence for

the purpose of participating in the Allegheny Intermediate Unit Apprenticeship Program.

Date: Signed by:

If a minor, also signed by:

(Parent or Guardian)

EMERGENCY INFORMATIONPLEASE PRINT

Name

School

School Contact and Phone Number

Emergency Contact & Phone Number

PLEASE LIST ANY SPECIAL NEEDS RELATIVE TO PHYSICAL CAPABILITIES, DIETARYRESTRICTIONS OR TAKING MEDICATIONS THAT YOU MAY HAVE:

Please provide an updated e-mail address that can be used to contact students with important information

regarding the Apprenticeship.

E-MAIL ADDRESS:(please print)

7/27/2019 AIU Waiver and Photo Release

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Allegheny Intermediate Unit

Photograph Release Form

I, _________________________(print name), hereby grant to the Allegheny Intermediate Unit permission to display

and share electronically via the Internet and/or in other displays and/or in the news media photographs of me taken in

conjunction with my participation in:

Event Name

By signing this release, I understand and consent that photographs of me may be electronically displayed by theAllegheny Intermediate Unit or by the news media. I also understand that the Allegheny Intermediate Unit's display of

photographs of me on the Internet and/or in other displays and/or in the news media will allow the photographs to be viewed by

the general public.

If any of the above-listed works and/or materials are displayed on the Internet by the Allegheny Intermediate Unit

and/or used in other informational displays, then I would like the following credit to be used:

(You may use your name, initials or a combination thereof, or indicate "no credit" if you do not want your name used at all. If no choice is

indicated by you, it will be deemed you choose "no credit.")

Credit Name

By signing this form, I acknowledge that I have completely read and fully understand the above release and agree tobe bound thereby.

Full Name:

Home Address:

State: Zip:

School District:

District Address:

State: Zip:

Phone: (H) (W)

Students Date of Birth: E-Mail Address:

Student's Signature: Date:

If this release is obtained from a student under the age of eighteen (18), then the signature of that student's parent orlegal guardian is also required.

Parent's Signature: Date:

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