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
-----------------------------------------------------------------------------------------------------------------------------
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___________
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 ___________
