I have read the above rules and will observe them while in the laboratory.
 
 

_____________________________            ________________________________

Name (please print)                                          Social Security Number or Student Number
 
 

______________________________          ________________________________

Signature                                                             Date
 
 

_____________________________             _____________________________

Course Number (if applicable)                          Course Name (if applicable)
 
 

Status (circle one or both as applicable):      employee           student