Media Release Non-Consent Form

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If you DO NOT grant permission for the Long Island Science Congress to release your student’s name and photograph, you must complete and submit this Media Release Non-Consent form no later than ten days prior to the day the student attends the science congress. Please note that the Media Release Non-Consent Form is available on the LISC website and a submitted form is considered valid for one (1) school year.

By signing and returning this form to LISC, Inc., I formally state that I DO NOT grant permission to Long Island Science Congress, Inc. to release my child’s name and photograph; or to display such photographs on the LISC, Inc. website.

Last Name of Student *

First Name of Student *

Name of school *

Student Grade *

LISC Division Student Will Participate In

I understand fully the conditions set forth in submitting this form.

Name of Parent/Guardian *

Email of Parent/Guardian *

Submit

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