Student Name *

First Name

Last Name

Student Grade *

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5th grade

Your relationship to student *

Parent/guardian

Teacher

Other

Photo Waiver Terms *

I am the parent/legal guardian of this student OR I have permission from this student's parent/legal guardian OR am an 18+ year-old student, and I hereby grant the Julia Robinson Mathematics Festival permission to publish: my photograph/s and this student's photograph/s in Julia Robinson Math Festival publications and/or on the websites of the Julia Robinson Mathematics Festival (www.jrmf.org), the San Francisco Math Circle (www.sfmathcircle.org), and associated organizations (aimath.org, msri.org) as well as any organization providing publicity for the Festivals. I understand that I have the right to request, in writing, removal of the photo from the Festival websites within 30 working days of receipt of the request by the JRMF. I understand that this photo may be used in Festival publications or on a website designed to promote the Festival programs as well as to offer information and resources.

I am the parent/legal guardian of this student OR I have permission from this student's parent/legal guardian OR am an 18+ year-old student, and I DO NOT grant the Julia Robinson Mathematics Festival or the San Francisco Math Circle permission to publish my photograph/s and this student's photograph/s. (Note that you are declining to sign the photo/video release. Please approach the organizer upon arrival to request a special tag that will inform the staff to avoid photographing/filming you/your child.)

Parent/Guardian Consent *

I am the parent/legal guardian of the above listed student, who is under age 18

I have permission from a parent/legal guardian for the student listed above, who is under age 18

I am an 18+ year-old student

Privacy Policy *

I consent to my submitted data being collected and stored as outlined. Contact information provided on JRMF registration forms will never be shared outside of our organization without your express written consent. If you are the parent or guardian of a child under the age of 15 who has submitted this form and you would like your child’s personal information removed from our database, please email info@jrmf.org. Please include “Personal Data Removal” as the subject heading and include the name and email address used by your child on the form in the body of your email message.

Would you like to be contacted about future Julia Robinson Math Festivals? *

Yes

No

Would you like to be contacted about San Francisco Math Circle classes / summer camps? *

Yes

No