SciRegistrationForm

I. School and Student Identification
Student Name: _______________________________________Grade_____________

School:_______________________________________________________________

Home Address:_________________________________________________________

                    _________________________________________________________

Sponsor’s Name: _______________________________________________________

Team Name (if applicable):________________________________________________

Project Title: ___________________________________________________________

II. Project Category (check one)
Behavioral Science (    )                        Botany (    )                                 Chemistry (    )
Microbiology (    )                        Biochemistry/Molecular Biology (    )         Mammalian Biology/Zoology (    )
Physics & Astronomy (    )                        Pharmacology/ Toxicology (    )                 Environmental Science (    )
Earth Sciences/ Planetary Sciences/ Physical Environments (    )
Software Engineering Design Competition (   )
Civil Engineering Applications (Pasta Bridge Competition) (    )
Recycling Electronics: The Phoenix Project        (     )

III. Talent Release Information
This release allows the NH Science & Engineering Exposition Steering Committee to use photographs, video,
audio of and other materials featuring the undersigned subject in promotional and other materials concerning
promotion and publicity of the NH Science & Engineering Exposition.
I hereby give the NH Science & Engineering Exposition Steering Committee the absolute and irrevocable right and
permission, with respect to photographs, videotapes, and audio recordings taken of me, or in which I may be
included with others:
a) To copyright the same in the name of the organization or any name so chosen.
b) To use and re-use, publish and re-publish, broadcast and re-broadcast the same in whole or in part,
individually or in conjunction with other photographs an videos in any medium for any purpose, including but not
limited to illustration, promotion, and advertising.
c) To use my name in conjunction therewith.
I hereby release and discharge the NH Science & Engineering Exposition Steering Committee from any and all
claims and demands arising out of or in connection with the use of the photographs, videotapes, and audio
recordings, including all claims for libel.

The authorization and release shall also ensure to the benefit of the legal representatives, licensees and assigns
of the NH Science & Engineering Exposition as well as the person(s) who secured the photographs, videotapes,
and audio recordings on their behalf.
Reproductions may be used in the following manner:
Local, Regional or National press releases and newsletters
NH Science & Engineering Exposition and/or NH Department of Education Brochures, Posters, Websites

IV. Signatures
Student Acknowledgment: I have read and I understand the Talent Release Information, as well as the Rules and
Regulations of the New Hampshire Science and Engineering Exposition. I will adhere to all Rules and Regulations
when conducting and presenting this project.   I understand that participation is voluntary and that there are risks
associated with participation.

___________________________        ________________________________                ____________
Student’s Printed Name                         Signature                                                                 Date

Parent/Guardian Approval: I have read and I understand the Talent Release Information, as well as the Rules and
Regulations of the New Hampshire Science and Engineering Exposition and I consent to my child participating in
this project. I understand that participation is voluntary and that there are risks associated with participation.

___________________________        _______________________________                ____________
Parent/Guardian’s Printed Name           Signature                                                               Date

Teacher Approval: I have read and I understand the Rules and Regulations of the New Hampshire Science and
Engineering Exposition and have reviewed that with this student. I agree to sponsor the student named above
and assume responsibility for compliance with all Rules and Regulation for the New Hampshire Science and
Engineering Exposition as well as all state and local safety regulation. I understand that participation is voluntary
and that there are risks associated with participation.

__________________________        _______________________________                ____________
Teacher’s Printed Name                       Signature                                                              Date