Safety Agreement & Release

Submitted by: Cathy Kerch, Hawaii
Participation/Permission to use tools form below

(Name of School) VISUAL ARTS SAFETY AGREEMENT & RELEASE:

In the Visual Arts classroom, students learn to work with various art tools that are used in the everyday creation of art.  These tools include and are not limited to: pencils, brushes, scissors, X-acto knives, linoleum cutters, carving tools, wire cutters, pliers, screw drivers, hammers, paper cutter, sand paper, wire, foil, rollers, printing press, various types of clays, glazes, plaster, rubber cement, spray adhesive, plastic wrap, Styrofoam, Chalk, pastels, paints, varnish, turpentine and paints.  Every precaution and preparation is taken to provide students with proper instruction prior to the use of these tools.

 

Cleanliness is also an important aspect of art, as well as a means of safety for your child and all students who use the Visual Art classroom.  Students are required to clean up their work area and tools before leaving the classroom using the following cleaners; Dove soap/water on brushes, mild detergent/water on tables and a broom to sweep the floor.  Some cleaners may be Clorox based or contain ammonia, if you do not want your child using any of these products please indicate so on the form below.

 

Every effort is made to provide your child with a safe environment to learn and work in however accidents do happen even under the strictest supervision.  Therefore, I am asking each parent discuss with your child the importance of listening and following directions when using these tools and cleaners in the Visual Arts classroom.  If you do not wish your child to use one or more of these items please let me know and I will attempt to accommodate your child with an alternative tool or provide him/her with a separate project from the rest of the class.

 

Sincerely,

(Teacher's Name)

Visual Arts Instructor

 

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PLEASE CUT & RETURN THIS HALF TO (teacher's name):

 

_____ I READ AND DISCUSSED WITH MY CHILD THE SAFETY POLICY FOR THE VISUAL ARTS CLASSROOM.

 

I DO NOT WISH MY CHILD TO USE THE FOLLOWING ITEMS___________________________________

________________________________________________________________________________________

________________________________________________________________________________________

 

PARENT or GUARDIAN SIGNATURE: ______________________________________ Date___________________

 

E-Mail:_______________________________________    Phone No. _________________________________

 

STUDENT SIGNATURE: _______________________________________________ Date___________________

 

GRADE:______________________                  Class section____________________

 

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Name of School Visual Arts Participation/Parent Permission Form

(PLEASE PRINT) Must be completed in full, use ink please! (PLEASE PRINT)

 

ID# _________________

 

Name ___________________________________________________________________ Grade ___________
         Last                                   First                                                    M.I

Home Address ____________________________________________________________________________
                      Street                                                          City                                          Zip Home Phone _________________________ Cell Phone __________________ Parent work phone ___________________

 

Alternate Contact if unable to contact Parents:

 

Name __________________________________________              Phone ______________________

 

Family Physician __________________________________              Phone ______________________

 

Dear Parents,

Students in 7th grade class at (name of school) will be working on a linoleum printing lesson. All students will be shown proper cutting methods to insure safety, however, minor accidents may happen. Students will be shown how to use a bench hook and correct placement of hands to prevent cuts.  Please fill out the above information and sign below. An alternate project will be assigned to those not permitted to use linoleum cutting tools.

Thank you for your support.

 

Teacher’s name and signature

 

___________________________________________________________________________

 

I understand that my son/daughter requests to participate in a linoleum printing project at (name of school) I fully acknowledge that physical hazards may be encountered and hereby waive any claim for damages against the (name of school) Board of Education or its representatives, made by me or other persons on my behalf, in case of personal injury. I hereby give my consent to my son’s/daughter’s participation in the linoleum printing project.

I hereby give permission for Emergency Medical treatment by the school nurse or medical personnel for conditions arising from this activity and for the health office to share health information with all employees having a need to know. I give my permission to share pertinent health information with appropriate (name of school) staff.

 

Parent/Guardian Signature _______________________________Date ___________

 

I agree to follow all safety precautions in using linoleum cutting tools

 

Student Signature ______________________________                Date _______________

 

I do not grant my son/daughter permission to participate in the linoleum printing project. I prefer my son/daughter to do the alternate printing project.

 

Parent/Guardian Signature _______________________________Date ___________