Form 1775 Emory CIREN Photo release

STUDY00005031
IRB Approved
9/27/2022

PHOTO RELEASE
Emory/Grady Crash Injury Research and Engineering Network (CIREN)
By signing below, I grant the Emory/Grady CIREN team and the National Highway Traffic Safety
Administration unlimited, unrestricted rights to the use of photographs and other images of me
or my minor children and my vehicle in publications and on internet sites. I acknowledge that
the study team members will follow accepted procedures for removing information that could
be used to personally identify me or my children.
________________________________________________________________________
Signature of Subject
Date
Time

PEDIATRIC ASSENT
Emory/Grady Crash Injury Research and Engineering Network (CIREN)
For subjects 11 to 17 years old: if you agree to have your photos used by the Emory researchers
and the sponsor, please sign your name below.
________________________________________________________________________
Signature of 11 to 17-year-old Subject
Date
Time

________________________________________________________________________
Signature of person soliciting assent of 11-17 year old Subject Date
Time

Version 1.0, July 24, 2017