Berrien County Mathematics and Science Center
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The Center occasionally takes photographs or tape video for use in Center
materials, news releases and other communication. Please help us by
signing this release and return it to the Center. I authorize Berrien County Mathematics & Science Center to video- tape and photograph my image and/or voice for use in research, educational, and public service programs. I understand and agree that these audio, video, film and/or print images may be edited, duplicated, distributed, reproduced, reformatted, and translated into other languages in any manner without payment of additional fees, in perpetuity.
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| Name of Student: (please print) |
| Student's Signature: |
| Parent's Signature: |
| Date: |