Hawai‘i State Science Olympiad Tournament Release Form – 2017

This form MUST be signed and submitted to the head coach on the day of the regional tournament.

The Hawai’i State Science Olympiad videotapes and photographs its tournaments. We use these recordings exclusively for noncommercial, educational, and promotional purposes, which may include open-circuit (broadcast), closed circuit, and/or cable television transmission, postings on the Hawai’i State Science Olympiad website, and mailings to schools and supporters within or outside the State of Hawai’i.

There is no financial or other remuneration for recording students, either for initial or subsequent transmission or playback. The Hawai’i State Science Olympiad is not responsible for any expense or liability incurred as a result of a student’s participation in a recording, including medical expenses due to any sickness or injury incurred as a result.

The Hawai’i State Science Olympiad may also use my name, likeness and/or bibliographical identification for publicizing and promoting the use of these recordings.

______☐ Yes ☐ No

Name of Student (please print)

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Signature of Parent or Guardian (if above student is under 18 years of age)

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Address City State Zip Code

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Home Phone Number

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For Statistical Purposes Only: Circle ONE answer for each question

Are you: Male Female

Do you identify yourself as: Caucasian Black/African-American Latino Japanese

Hawaiian Korean Chinese Filipino Pacific Islander Other

Grade: 6th 7th 8th 9th 10th 11th 12th

How old are you:

Is this your first Science Olympiad Tournament? Yes No

Have you considered science, technology, engineering, and/or math as a possible career? Yes No

If so, which of the following majors is closest to the career in which you are interested?

Astronomy Chemical Engineering Physics Computer/Internet

Biology Structural Engineering Genetics Mathematics/Statistics

Chemistry Civil Engineering Zoology Other: ______

Medicine Electrical Engineering Geology

To what colleges/universities have you applied (will you apply)?

Have you/Do you participate any of the following science competitions?

Hawaii State Science and Engineering Fair

Robotics (i.e. Lego, FIRST, Robofest)

Science Bowl

The above information is for Science Olympiad purposes only. Statistical information allows HSSO improve the quality of the annual tournaments as well as gain funding from individuals and organizations to benefit students.