Physical Science Syllabus Signature Page
kitty.rigdon@douglas.k12.ga.us
770.651.2745
To view the course syllabus:
Get registered on https://myhomeworkapp.com/ and find the “Physical Science Syllabus” document under
“Assignment” on your teacher’s page.
---OR---Go to school website @ http://tinyurl.com/ganmhs (you can access the teacher’s website by going to
school staff AND choose the teacher). Click on the “Forms” link on the New Manchester Website and click
on “Lab Safety Contract” and “Physical Science Syllabus”.
I, type student’s name here, have read and understood the classroom guidelines and procedures for Ms.
Kitty Rigdon’s Spring 2016 Physical Science class, detailed in the syllabus, found at the above links. I
agree to comply with all policies and regulations therein stated.
Student Name:
type student’s name here for signature
Student Email: type
Date:
type date here
student’s email address here
I, the PARENT OR GUARDIAN of the above student, have read and understood the class policies and
regulations for Physical Science detailed in the syllabus, found at the above link.
Parent/Guardian Name:
type parent’s name here for signature
Parent’s Updated Email: type
Date:
type date here
parent’s email address here
Parent’s Updated Phone Number(s): type
parent’s phone number(s) here
Please REPLACE ALL HIGHLIGHTED AREAS above
and on the next page with the REQUESTED
INFORMATION.
Please be sure to scroll down to the next page to
sign the Flinn Lab Safety Contract………
You do not need to print these pages. Please
submit via email (instructions on next page).
PHYSICAL SCIENCE signature page Spring 2016 (fill in electronically, send back via email)
To view the Flinn Scientific Safety Contract:
Get registered on https://myhomeworkapp.com/ and find the “Lab Safety Contract” document under
“Assignment” on your teacher’s page.
---OR---Go to school website @ http://tinyurl.com/ganmhs (you can access the teacher’s website by going to
school staff AND choose the teacher). Click on the “Forms” link on the New Manchester Website and click
on “Lab Safety Contract”.
Flinn Scientific’s Student Safety Contract Signature Form
AGREEMENT
I, type student’s name here, (student’s name) have read and agree to follow all of the safety rules set forth in this
contract. I realize that I must obey these rules to ensure my own safety, and that of my fellow students and instructors. I
will cooperate to the fullest extent with my instructor and fellow students to maintain a safe lab environment. I will also
closely follow the oral and written instructions provided by the instructor. I am aware that any violation of this safety
contract that results in unsafe conduct in the laboratory or misbehavior on my part, may result in being removed from the
laboratory, detention, receiving a failing grade, and/or dismissal from the course.
QUESTIONS
56. Do you wear contact lenses?
YES
NO
leave correct answer, delete wrong answer
57. Are you color blind?
YES
NO
58. Do you have allergies?
YES
NO
If so, list specific allergies: list allergies if any, or type “none”
Student Signature: type
student’s name here for signature
Date: type
date here
Dear Parent or Guardian:
We feel that you should be informed regarding the school’s effort to create and maintain a safe science
classroom/laboratory environment. With the cooperation of the instructors, parents, and students, a safety instruction
program can eliminate, prevent, and correct possible hazards. You should be aware of the safety instructions your
son/daughter will receive before engaging in any laboratory work. Please read the list of safety rules above. No student
will be permitted to perform laboratory activities unless this contract is signed by both the student and parent/guardian and
is on file with the teacher. Your signature on this contract indicates that you have read this Student Safety Contract, are
aware of the measures taken to ensure the safety of your son/daughter in the science laboratory, and will instruct your
son/daughter to uphold his/her agreement to follow these rules and procedures in the laboratory.
Parent/Guardian Signature:
type parent’s name here for signature
Date
type date here
email this file to: kitty.rigdon@douglas.k12.ga.us
SUBMISSION INSTRUTIONS: To ensure the confidentiality of parent/teacher contact,
this file should be attached and emailed from the PARENT’S E-MAIL ONLY!
Include in the SUBJECT box the following: Syllabus/Safety--PS-student’s full name
PHYSICAL SCIENCE signature page Spring 2016 (fill in electronically, send back via email)