Suite 200
Baltimore, MD 21202
410 385-6323
SciTech Student Learning Lab
PARTICIPANT RELEASE AND INFORMED CONSENT AGREEMENT
SciTech Student Learning Laboratory (“SciTech”) is a bioscience learning laboratory for teachers and students at Towson
University’s Center for STEM Excellence. The undersigned, on behalf of myself if
I am a participating adult and/or my minor child
listed below if he or she is participating (“Participant”), give permission for Participant to visit SciTech and to take part in the
activities of SciTech and Towson University (“TU”), and to handle and use sensitive scientific equipment, computers, materials
and chemicals.
In connection with and in consideration of Participant’s participation, the undersigned, on behalf of myself, Participant and any
heirs, personal representatives and assigns, acknowledge, agree and consent as follows:
1. Voluntary. Participant’s participation is completely voluntary. Participant is not required to participate.
2. Follow Rules. Participant will abide by and follow all applicable laws, all applicable rules and standards of conduct of
SciTech and TU, and all directions and instructions of SciTech and TU personnel. TU reserves the right to limit or
terminate Participant’s participation if, in the sole discretion TU or SciTech personnel, Participant’s actions or conduct do
not conform to the foregoing, or otherwise are dangerous, destructive or disruptive.
3. Risk. I fully understand and acknowledge that: (a) risks and dangers exist in my child’s use of laboratory equipment and
my child’s participation in SciTech activities which may result in injury, illness, death or damage to personal property
caused by other participants, by accidents, or by the forces of nature of other causes, (b) risks and dangers may arise
from foreseeable or unforeseeable causes and I hereby accept and assume these risks and dangers for myself and on
behalf of my child participating in such activities.
4. Photos, Images, Participant Work. TU and SciTech have the right to take photos and record audio/video images of
Participant, to use them, and to reveal or use Participant’s name in connection with them, for educational and/or
promotional purposes. Any right to exhibit them (including Towson University’s web site) is released irrevocably to TU,
and any right, claim or interest that the undersigned and/or Participant may have to control the use of Participant’s
identity or likeness in them, including libel or invasion of privacy is waived irrevocably. Any educational and/or
promotional use of same may be made without compensation or consideration to the undersigned and/or Participant. TU
has the right to use examples of Participant work (no student names will be associated with Participant work) as part of
educational workshops and publications.
If any portion of this agreement is held invalid, the balance of this agreement, notwithstanding, continues in full force and effect.
I have read the above and by signing it agree it is my intention to grant permissions for my child to participate in SciTech
activities and to assume all risks associated therewith on my behalf and on behalf of my child.
Emergency Contact Phone (For
Participant)
Signature of Adult Participant - OR - Parent/Guardian Having Care/Custody of Participating Minor
