Nursing and Health Sciences Open House

Student First Name*

Student Preferred First Name (If Different)

Student Last Name*

Student Birthdate*

Student Mailing Address*

Country

Street

City

Region

Postal Code

Student Mobile Phone Number

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Student Email Address*

High School*

Year of Graduation*

Anticipated Enrollment Term*

Anticipated Enrollment Year*

Anticipated Student Type*

Major/Interest

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Relationship

Number of Guests (not including student)*

Will you or your guests need any specific accommodations during your visit (physical, language, allergies, etc)?

I hereby grant Edgewood University the irrevocable right and permission to use photographs and/or video recordings of me on university and other websites and in publications, promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me.

I understand and agree that such photographs and/or video recordings of me may be placed on the Internet. I also understand and agree that I may be identified by name and/or title in printed, Internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof, and all digital files are and shall remain the property of the University.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has approved this release.

I agree