Museum of Science Consent Form
2025 - 2026 MoS PRORGRAM RELEASE FORM
Dear Parent/Guardian,
Your child is enrolled in an exciting, innovative hands-on medical science curriculum, (www.hmsmedscience.org) as part of their school program. This program strives to increase science literacy and develop interest in science/health careers. In order to help assess the impact and effectiveness of this program on its participants, we administer both “before” and “after” program surveys to assess the quality of our program. We also collect, analyze and showcase the outcomes of these programs in various formats. These outcomes are shared with the public, the Harvard Medical School community, our funding agencies, researchers who study our program outcomes, and other interested parties who support our program. All student information collected for the purpose of program assessment will be analyzed confidentially and all video will use first names only. Each student must return this signed form in order to participate with the class at Harvard Medical School.
The HMS MEDscience Team & The Museum of Science
I, the undersigned, give consent for my student (“the Student”) listed below to participate in the Museum of Science program for the 2025-2026 school year.
I warrant that I am the parent or legal guardian of the Student and have the full right and authority to grant this consent on behalf of them.
I authorize the Museum of Science (“the Museum”) to photograph, film, and otherwise make recordings of the image, voice, or both of the Student (“the Recordings”) in connection with participation in activities during the time in which they are enrolled as a student.
I hereby agree that the Museum will have the irrevocable, worldwide right to produce, copy, edit, publish, distribute, show, broadcast, display, and otherwise use and make available the Recordings and any works derived from them, regardless of whether these materials are used for educational purposes, marketing, or any other purpose on behalf of the Museum. I acknowledge that such use of the Recordings may include the Student’s name and other non-confidential biographical information, such as their program, full name, or school year. I understand that the Museum may choose not to make use of the Recordings at this time but may do so at its own discretion at a later date.
I waive all claims to compensation or damages (including, but not limited to invasion of privacy, defamation or other injury to reputation, and violation of rights of publicity) based on the use of the student’s image, voice, or both by the Museum. I also waive any right to inspect or approve the finished Recordings.
I understand that I will not receive royalties or any payment in connection with the Recordings or for granting this release.
I give consent for follow up contact with the Student using school contact information for the purpose of learning how the Student is progressing with their academics and future careers.
I further hereby, on behalf of myself, the Student, and anyone claiming through myself or the Student to forever release the Museum, its trustees, officers, members of its governing boards, employees, volunteers, students, agents, and assigns from any cause of actions, claims, or demands of any nature whatsoever, including but not limited to a claim of negligence which I, the Student, or anyone claiming through myself or the Student, may now or in the future may have on account of personal injury, bodily injury, property damage, death, or accident of any kind arising out of or in any way related to the student’s participation in the program.
I understand this consent is perpetual, that I may not revoke it, and that it is binding on the Student, our heirs, and assigns. I have read this release and fully understand its contents. This release is signed as a document under seal governed by the laws of the Commonwealth of Massachusetts.