HiTech Virtual Reality Safety Form HiTech Conference VR Acknowledgement Form Student's Name* First Last Student's Age*Student's Date of Birth* MM DD YYYY I understand that: Certain inherent conditions that pose potential risks and dangers are present, such as low levels of radiation, while using virtual reality equipment. Use of VR equipment can lead to accidents, injury, illness, etc., to include nausea, discomfort, eye strain, eye or muscle twitching, vision abnormalities, loss of awareness, dizziness, excessive sweating, increased salivation, impaired hand-eye coordination, drowsiness, fatigue, impaired balance, and disorientation. It is important to consult with my child’s doctor or other health practitioner if they are prone to seizures or other symptoms linked to an epileptic condition, have pre-existing binocular vision abnormalities, or suffer from a heart condition or other serious medical condition before engaging in this activity. The headset can emit radio waves that can affect the operation of nearby electronics, including cardiac pacemakers. Virtual Reality headsets can aggravate symptoms of squint, amblyopia, or anisometropia. I further understand that: Participants must be at least 11 years of age. My child will be required to take frequent breaks when using the equipment. HCLS staff will call 911 in the event of an emergency. Release from Liability. I, my successors and assigns, agree to release, discharge, indemnify and hold HCLS and Howard County, (MD), their officers, employees, and agents, harmless for any and all damage to my and/or my child’s person or property while I and/or he/she is participating in this class/activity/event. Parent or Guardian Name* First Last By entering my name, I acknowledge and accept the terms and conditions in this form.Date* MM DD YYYY Parent or Guardian Phone Number*Parent or Guardian Email* CAPTCHA