Cypress Fairbanks ISD Agricultural Science Classrooms

Dear Parents,

Please read the outline of information to be covered in the Agricultural Science classes offered through the Cypress Fairbanks ISD Agriculture Science Department.

Due to the nature of the training associated with the pathway, you are advised that it is likely there will be live small and/or large animals in the lab setting on a regular basis. You are informed of this in the event of allergies to fur, pet dander, latex etc. that might be a health factor if you have a child with severe allergies. Laboratory tools and medical equipment including syringes, dissecting equipment, chemicals etc. will also be used over the duration of these courses. It is planned that there will be live demonstrations during the courses offered in this pathway. All necessary precautions will be taken to insure the safety of every child. Please inform us if you or your health care provider has a concern regarding the presence of the animals or laboratory equipment. We are interested in providing a career avenue for your child in the animal systems pathway. Below I am asking for your signature indicating that you are aware of what will be required of your child. Your son/daughter has also been asked to sign indicating his/her willingness to cooperate.

Your child has expressed an interest in the class and we hope you will consent to their participation.In order for a student to participate in shop related courses at Cypress Fairbanks ISD it is necessary for him/her to have a release form signed by you. Therefore, I am also asking that you please sign the release form on the back of this sheet and return it to the instructor as soon as possible.

Sincerely,

Cypress Fairbanks ISD Ag Science Instructors

ACKNOWLEDGMENT OF INFORMATIONAND PERMISSION TO PARTICIPATE IN LABORATORY ACTIVITIES

I, ______, (parent) have familiarized myself with the animal systems pathway course packet. I understand what will be expected of my child during this class. I am especially aware that this is a lab class and I give my child permission to work with or work around animals, tools, chemicals and other materials that require a safety-conscious attitude and mature behavior.

Parent Signature: ______Date: ______

Home phone: ______Work phone: ______

I, ______, (student) have read the animal systems pathway course packet. I understand what will be taught in this class. I have read the regulations and agree to abide by them. I will adhere to safety procedures and use tools and other materials properly. If I do not, the consequences will be reflected in my grade and my participation in any lab situations.

Student Signature: ______Date:______

Animal Systems Pathway Course:______

PLEASE COMPLETE BOTH SIDES OF THIS FORM.

Pg.1

EMERGENCY INFORMATION

Medical Statement/Liability Release

(To be filled out by Parent or Guardian)

Student Name: ______

Parent or Guardian Name: ______

Home Phone#: ______

Work/Cell & Emergency Phone #'s

1. ______

2. ______

3. ______

Contact Name in case of Emergency: ______

Emergency Phone#: ______

MEDICAL STATEMENT

Please provide the following information. This information will be kept on file for reference purposes.

1. Drug Allergies? ______

2. History of Medical Disorders? ______

3. Physical Limitations? ______

4. Other conditions we should be aware of ______

5. If I cannot be reached, my Doctor is ______

Doctor's Phone# ______

LIABILITY RELEASE

This is to certify that ______has insurance and/or that the Cypress Fairbanks ISD Board of Education, its representatives, agents, and employees are released from any liability for any injury and/or medical expenses that might result from a laboratory related accident involving this student in the animal science pathway at Cypress Fairbanks ISD.

______
Parent’s Signature Date of Signature