PLYMOUTH PUBLIC SCHOOLS
PILGRIM SCIENCE FAIR
Chemical Release Form
Student _______________________ Course ____________________
Teacher _______________________
I requested the following chemicals for my childís science project:
Cost: Chemical Name: Amount: Hazard:
$_______ ______________________________ _____ _____________________
_______ ______________________________ _____ _____________________
_______ ______________________________ _____ _____________________
_______ ______________________________ _____ _____________________
_______ ______________________________ _____ _____________________
_______ ______________________________ _____ _____________________
_______ ______________________________ _____ _____________________
_______ ______________________________ _____ _____________________
$______ Total Cost
I have been informed of the proper handling procedures and special hazardous qualities of each of the above chemicals. I will supervise my child in their use and disposal. I will NOT hold the school authorities LIABLE in the event of injury caused by any of the above chemicals. I also agree to pick up the requested chemicals at school and transport them home in my personal vehicle.
Date_____________________ Signature
_________________________________
(Parent/Guardian)