INDIAN RIVER STATE COLLEGEEDUCATIONAL TALENT SEARCH - SLCPARTICIPANT APPLICATION

The Family Educational Rights and Privacy Act of 1974 prohibit the disclosure or release of privileged and confidential information. All information obtained by Indian River State College Educational Talent Search-St. Lucie County office remains confidential

Dear Parent or Guardian:
IRSC’s Health and Wellness Center provides student health care services under the supervision of a registered nurse. It is necessary for you to sign this form for your child to receive student health care if he/she is under the age of 18. Parents will be responsible for updating and notifying IRSC’s Health and Wellness Center of any changes which will authorize treatment for your child. Your signature below authorizes the appropriate treatment for your child, which may include:
1. First Aid Care.
2. Treatment of health problems (stomachaches, earaches, headaches, cuts, sores, colds, coughs, ringworms, etc.).
3. Minor Emergency Care.

If you have any questions, please contact the Health and Wellness Center at 772-462-7825

I authorize the release of school records for the applicant’s file that may be requested by Educational Talent Search at Indian River State College. I understand that the U.S. Department of Education funds Educational Talent Search and will use these records to provide academic advisement and other services. I also understand that these records will be handled in a confidential manner and that they will be made available only to program staff and representatives from Federal and State Departments of Education.

This authorization release includes, but is not limited to, the following records:

- Official School Transcript
- Student History File with test scores
- National Student Clearinghouse
- Attendance Record
- Student grades/progress reports
- Information concerning disciplinary actions
- Test Results (PSAT, SAT, ACT, PERT)

Note: A photocopy of this record release form should be accepted as an original and the date of the application has no bearing when the Indian River State College Educational Talent Search Program requests the information.

MEDICAL AUTHORIZATION
If medical services are needed by my son/daughter while participating in the Educational Talent Search program or on field trips, I give my permission for my son/daughter to receive any medical services deemed necessary.

ACTIVITY AND FIELD TRIP AUTHORIZATION/RELEASE
As the parent/guardian of the applicant I do willingly execute this release in consideration of the educational benefit to be derived by my child in participating in Educational Talent Search, a College sponsored activity. I hereby release from liability and hold the College harmless from any and all claims and causes of action which might be brought by my child for loss of property, personal injury or death sustained by my child arising out of travel or activity conducted by or under the control of the College. I understand that the term “College” as used herein shall include the employees, administrators, agents, and Board of Trustees of the College.

PHOTO RELEASE
I hereby grant Indian River State College Educational Talent Search permission to photograph/video my son/daughter and/or to use their likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Indian River State College Educational Talent Search, in perpetuity, and for other uses by the College or Program. I will make no monetary or other claim against Indian River State College Educational Talent Search for the use of the photograph(s)/video. By signing, I hereby acknowledge and certify that the information contained in this application, and any attached supporting documentation provided, is true and correct.