Student's Last Name______________________________

Information Sheet

Name(Student) ( First, Last,Preferred) _____________________________________________

Contact Name (First, Last, Relationship) ____________________________________________

Contact Phone Number__________________________________________________________

Contact e-mail address(parent)____________________________________________________

Contact e-mail address(student)___________________________________________________


  1. Do you have Internet access at home? 
    • ___  Yes  ____No

  2. Are you color blind?
    • ___  Yes  ____No

  3.  Do you have an after school job?
    • ____Yes  ____No  
    • How many hours per week?______
Record of Home Contact
Do not write in this box
Procedures and Rules Acknowledgment

I, ________________________ (student's name) have read and agree to follow all of the, policies, procedures, classroom rules, and lab safety rules set forth in the class syllabus found on my courses Procedures page on If I have a question about any portion of the syllabus I will ask my teacher for clarification. I realize that I must obey these rules to insure my own safety, and that of my fellow students and instructor. I will cooperate to the fullest extent with my instructor and fellow students to maintain a safe classroom and 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 conductions in the laboratory, or misbehavior on my part, may result in being removed from the laboratory, receiving a detention, receiving a failing grade, and/or dismissal from the course.

Student Signature Date

Dear Parent or Guardian,
We feel that you should be informed regarding the school's effort to create and maintain a safe science classroom and laboratory environment. With the cooperation of the instructor, parents, possible hazards can be corrected and prevented. You should be aware of all of the, policies, procedures, classroom rules, and lab safety rules your son/daughter will receive before engaging in class and laboratory work. Please read the list of these policies, procedures, classroom rules, and lab safety rules which are set forth in the class syllabus found on the Procedures page on If you have any questions please feel free to contact your student's teacher. No student will be permitted to perform laboratory activities unless this contract is signed by both the student and the parent/guardian and is on file with the teacher. Your signature on this contract indicates that you have read this syllabus and are aware of the measures taken to insure the safety of your son/daughter in the science class and laboratory as well as the grading procedure and the student's responsibilities for the course. It is also expected that you will instruct your son/daughter to uphold his/her agreement to the follow these rules and procedures in the class and laboratory.

Parent/Guardian Name (print) Signature Date