Kirkwood Family Day Registration & Photo Release
October 4, 2014 • Cedar Rapids Main Campus

Please park in the South Entrance Iowa Hall parking lot.

Are you a Kirkwood Alum?
Click HERE to register via our special Alumni Family Day Registration Form!

By registering for Kirkwood Family Day, you are automatically entered in
our drawing for prizes! Winners will be notified by phone prior to Family Day.
You must register by September 30 to be eligible for prizes. Registrations after
September 30 are still accepted, however, you will not be eligible for prizes.

*Student's First Name

*Student's Last Name

*Parents' Name(s)

*Mailing Address

*City, State


*Phone Number

*Email Address

*Total Number Attending
(Needed for food tickets)

Names of any Kirkwood Alumni Attending

Kirkwood Community College Authorization and Photo Release

All photographers taking photos on Kirkwood Community College's property or at Kirkwood events must obtain a signed release form from any student, faculty, staff or member of the public who is visibly recognizeable in the photograph. Photos of crowds in which no individual is the focus of the photograph are exempt. News events are also exempt, though if a photo taken for news purposes is being reused in promotional material, a release is then required.

This release is required for any promotional material of a marketing or public relations nature, including printed publications and for use online.

*You are

My photo is being taken for

*Allow my electronic signature
to denote my consent.


*Are you over 18 years old?


Parent Electronic Signature

                  * denotes required fields.

The undersigned hereby gives permission and authorization to Kirkwood Community College and its designees, agents and applicable media vendors to use and reproduce any still photographs, video or any other media forms that include my name or likeness, and use or reproduce any recording or other media form that includes my voice, in any approved Kirkwood Community College publication, website, social media, podcast, audio recording, promotional materials, video (including but not limited to video clips) or any other medium.

The undersigned further agrees that Kirkwood Community College is authorized and permitted to provide such media forms of my name, likeness or voice to the Kirkwood Community College Foundation for any approved Foundation media use as described above.

The undersigned releases and holds harmless Kirkwood Community College, the Kirkwood Community College Foundation and their designees, agents and applicable media vendors from any and all claims of libel, slander, invasion of the right of privacy or publicity or any other claim based on the use of my name, likeness or voice, and any and all damages, costs and expenses that may directly or indirectly arise from the use of my name, likeness or voice.