Release Form - Kid

RELEASE AGREEMENT FOR KIDS

“Cultural Maps, Cultural Tours”

Thank you for allowing your child to participate in the Dane County Cultural Tour.  By signing the form below, you give your permission for the Center for the Study of Upper Midwestern Cultures to:

  • Use recordings, photographs, or your child’s work produced during the Dane County Cultural Tour for educational purposes, including print and web publications and exhibitions;
  • Use photographs in which your child may appear for educational purposes, including publications and exhibitions;
  • Deposit these materials in the Center’s public archives where they can be made available to researchers and the public for scholarly or educational purposes.

By giving your permission you do not give up any copyright or other rights that you may hold.

In any publication and in the archives, children will only be identified by their first names.

I agree to the uses of these materials described above except for any restrictions listed below.

Signature of parent _________________________________

Signature of child __________________________________

Printed name of parent ______________________________ Date _________

Printed name of child ______________________________

Address __________________________________________

Restrictions:

Restrictions in effect until: _____________________

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This page last updated on November 5, 2002