HiTech Laboratory Acknowledgement Form Student's Name* First Last LABORATORY SAFETY PROCEDURES: Read the activity instructions before attempting any laboratory procedure. Long hair must be tied back when working in the laboratory. NO "horseplay" or "fooling around" is permitted. NO optional or original experiments may be conducted without prior approval or adult supervision. Do not taste any chemicals. Do not pour any unused chemicals back into stock bottles. When heated, test tubes should be pointed so the open end is not aimed at anyone. Broken glass should immediately be cleaned up and discarded into the container labeled for that purpose. Wash the laboratory table surface after you have finished the activity. Clean all equipment and return it to the storage area before leaving the laboratory work area. Report any accident or injury to the instructor immediately, then follow emergency procedures as necessary. EYE SAFETY: Education Law requires that students wear approved eye safety devices (goggles) whenever instructional programs involve the use of hot solids or liquids, caustic or explosive materials, and certain tools or machinery. In short, goggles must be worn in the laboratory at all times except when specifically told by the instructor that they are not needed. This is to certify that I have read the "Laboratory Safety Acknowledgment Form" and have been given ongoing verbal instructions from the classroom science instructor concerning safety procedures. I realize that failure to observe these instructions could result in serious injury to others and myself and acknowledges my responsibility towards the care to be used in handling all materials and equipment. In order to avoid damage to equipment and injuries to others, and myself I promise to observe and obey these rules at all times. If I neglect these safety rules I understand I may be removed from the laboratory portion of the course. I understand that: All or part of this class will take place in the HiTech Lab or in the outdoor classroom. Certain inherent conditions associated with the chemicals (i.e. Food coloring, 6% hydrogen peroxide (used in high schools), Bleach, 0.1 M HCl, Dawn dish soap, etc.) used in the experiments that pose potential risks and dangers. On one occasion an instructor demonstration will include the use of dry ice by the instructors and not the students. Certain inherent conditions that pose potential risks and dangers are present in the outdoor classroom—conditions that can lead to accidents, injury, illness, sunburn, allergic reactions, etc., even death, as my child will be exposed to the elements, forces of nature, as well as surroundings, that can cause same (for example: water—collected, standing, and moving; garden tools and implements; allergens; sun; plant life; insects and wildlife; natural terrain; rocks; and unfinished wood). I further understand that: This class may require my child to move to and from the interior of the Savage Branch and the outdoor classroom. My child will be directly exposed to existing weather conditions. My child must wear goggles and shoes at all times; as well as nitrile gloves when instructed. My child will be participating in labs except where noted above. HCLS staff will call 911 in the event of an emergency. No child under the age of 11 years old, will be able to attend the class. I, my successors and assigns, agree to save and hold harmless HCLS and Howard County, MD, their offices, employees, and agents, from all cost, injury and damage incurred as a results of my child’s participation in this class, and from any other injury or damage to any person or property whatsoever, resulting from my child’s participation in this class. Parent's Name* First Last By entering my name, I acknowledge and accept the terms and conditions in this form.Date* This iframe contains the logic required to handle Ajax powered Gravity Forms.