Science Lab Liability Waiver Form

Science Lab Liability Waiver Form
Please complete this form to participate in science lab activities and acknowledge the associated risks.
Participant Full Name
First NameLast Name
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
First NameLast Name
Emergency Contact Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please indicate any allergies or medical conditions we should be aware of (if none, write 'None')
Have you previously participated in science lab activities?
I acknowledge that I have read and understood the laboratory safety rules and agree to follow all instructions provided by lab staff.
Participant Signature
Powered by Jotform SignClear
Should be Empty: