UGDSB STUDENT SAFETY RECORD
STUDENT AGREEMENT
I have read the Course Outline and Student Safety Contract. I understand the policies of the science department and the
laboratory safety rules. I agree to follow these procedures to the best of my ability and take full responsibility for the
consequences, should I choose not to follow these procedures.
Student Name:
Course Code:
Student Signature:
Date:
PARENT AGREEMENT
I have read the Course Outline and Student Safety Contract. I understand the policies of the science department, and the
laboratory safety rules. I will encourage my son/daughter to follow these procedures to the best of their ability.
Parent/Guardian Name:
Date:
Parent/Guardian Signature:
Special Needs/ Medical Conditions of Student:
Allergies of Student:
Parent/Guardian Contact information
Home Phone Number:
Emergency Contact Number:
Parent/Guardian email:
Date
Safety Notes/Comments
This record to be retained for three years after completion of the school year in which the course occurred.