School Science Equipment Demonstration Consent Form
Use this form to provide parent or guardian consent for a student to participate in a school science equipment demonstration and share any important participation details.
Student Information
Student Full Name
*
First Name
Middle Name
Last Name
Grade/Class
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Age
*
School Name
*
Parent or Guardian Information
Parent or Guardian Full Name
*
First Name
Last Name
Relationship to Student
*
Parent
Guardian
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Demonstration Details
Demonstration Date
*
-
Month
-
Day
Year
Date
Demonstration Location/Site
*
Teacher or Staff Name
*
Description of Science Equipment or Demonstration Activity
*
Participation and Safety Information
Medical considerations or allergies
Mobility or accessibility needs
Emergency contact name
*
First Name
Middle Name
Last Name
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student restrictions the school should know about
*
No restrictions
Allergies
Asthma
Mobility limitation
Other
Media Permission and Consent
Photo and video permission for the demonstration
*
Yes, permission granted
No, permission not granted
Consent acknowledgment
*
I acknowledge that I have read and understood the participation and safety information for the science equipment demonstration and consent to my child’s participation.
Parent/guardian signature
*
Submit
Submit
Should be Empty: