Upward Bound Release Form Question Title * 1. Student Name Question Title * 2. Date of Birth Date Date Question Title * 3. ACTIVITY AND TRANSPORTATION RELEASE: I hereby give permission for my dependent to participate in all Upward Bound activities, trips, and events and for the Upward Bound program to arrange transportation to and from Upward Bound-sponsored events in university vans or in other vehicles driven by competent adults designated by the Upward Bound program. In addition, I give permission for persons affiliated with the Upward Bound program to visit my child at their school. Yes No Question Title * 4. PHOTO RELEASE: I hereby give my permission for my dependent's picture to be taken in connection with the activities of Upward Bound at VTSU - Castleton and its agencies for use in newspapers, on television and the internet, in magazine articles, in brochures, in the yearbook, and in presentations concerning the program. Yes No Question Title * 5. PHYSICAL ACTIVITY RELEASE: I hereby give permission for my dependent to participate in physical activities during the academic and summer programs. I am aware that participation in sports and other physical activities involves some risk of injury, and I have had the opportunity to discuss these risks with program administrators and/or faculty. Yes No Question Title * 6. INTERNSHIP PARENT PERMISSION RELEASE: I give my dependent permission to participate in a paid summer internship arranged by Upward Bound. I understand that the adult/s supervising the internship may not be employees of VTSU - Castleton or Upward Bound and, therefore, have not undergone general reference checks or a criminal background check, and I release the University and UB from any supervisory responsibility during the internship other than safe transportation to and from the internship location. Yes No Question Title * 7. EDUCATIONAL RECORDS RELEASE: I authorize VTSU - Castleton Upward Bound to receive copies of my dependent's transcripts, grade reports, test scores, and other materials necessary for application review and, if accepted, for the duration of their secondary and post-secondary education. Yes No Question Title * 8. Please sign your name consenting to the above. Question Title * 9. Today's Date Date Date Done