Student Safety Contract Agreement

I, ______________________________, (Student’s name) have read and agree to follow all of the safety rules set forth in this document.  I realize that I must obey these rules to ensure my own safety, and that of my fellow students and instructors.  I will cooperate to the fullest extent with my instructor and fellow students to maintain a safe lab environment.  I will also closely follow the oral and written instructions provided by the instructor.  I am aware that any violation of these safety rules and conditions that results in unsafe conduct in the laboratory or misbehavior on my part, may result in being removed from the laboratory, detention, receiving a failing grad, and /or dismissal from the course.

________________________________                                     __________________

(Student Signature)                                                                             (Date)

Dear Parent or Guardian:

We feel that you should be informed regarding the school’s effort to create and maintain a safe science classroom/laboratory environment.  With the cooperation of the instructors, parents, and students, a safety instruction program can eliminate, prevent, and correct possible hazards.  You should be aware of the safety instructions your son/ daughter will receive before engaging in any laboratory work.  Please read the list of safety rules in the previous pages.  No student will be permitted to perform laboratory activities unless this contract is signed by both the student and parent/ guardian and is on file with the instructor.  Your signature on this contract indicates that you have read these Safety Rules, are aware of the measures taken to insure the safety of your son/ daughter in the science laboratory, and will instruct your son/ daughter to uphold his/ her agreement to follow these rules and procedures in the laboratory.

___________________________________                                              _____________________

                (Parent/ Guardian Signature)                                                              (Date)

For information and safety purpose, do you (the student) wear contact lenses?

                _____ (yes)                                                          ____ (no)