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Child Participation Waiver & Parental Consent Form
LITTLE SCIENCE STUDIO
Curious Chemist (Ages 3–6)
537 Park Avenue Hoboken, NJ 07030
Program Description
Use of Materials
Assumption of Risk
Release of Liability
Medical Consent
Photography & Media Release (Optional)
Behavior & Participation Acknowledgment
Acknowledgment & Signature
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Parent/Guardian Name
*
First
Last
(if Child's Phone
Parent/Guardian Email
*
Child's Name
*
Child's Age
*
Allergies, medical conditions, or special needs (if any)
Emergency Contact Name
*
Emergency Contact Phone
*
Waiver Agreement (Parent/Guardian Consent)
*
I understand this is a science program for children age 3-6 and I give permission for my child to participate.
I understand there may be age-appropriate chemicals and I accept responsibility for communicating my child's needs.
I agree to the waiver for my child to participate in the science program.
Submit
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