Battery Consent Form
Please review and complete this form to acknowledge your understanding and agreement regarding battery usage and handling.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department or Affiliation
*
Battery Type
*
Please Select
Lithium-ion
Nickel-Metal Hydride (NiMH)
Lead Acid
Alkaline
Other
Battery Serial Number or Identifier
*
Purpose of Battery Use
*
Please Select
Research
Testing
Project/Experiment
Other
Expected Duration of Use (in days)
*
Have you received safety training for battery handling?
*
Yes
No
Please describe any known battery issues or concerns
Signature
*
Submit Consent
Submit Consent
Should be Empty: