I have read the safety policies of UA Little Rock and the policies specific to the research laboratory in which I am working, and they have been explained to me. I agree to follow all of these policies.

I acknowledge and understand that there are risks involved with activities as described in this form, and I agree to complete safety/hazard or other required training provided by UA Little Rock within one week of arrival at the Institution. I choose to voluntarily participate in this activity with full knowledge that the activity described may be hazardous to me.

I certify that I have adequate health insurance or my parent/guardian has insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my participation in these activities.

I hereby agree to hold harmless and release UA Little Rock and its Board of Trustees, its officers, agents, employees and representatives from all claims, demands, liabilities, rights and causes of action whatever kind or nature, that may result from or occur during my participation in these activities.

I HAVE CAREFULLY READ THIS DOCUMENT, IT HAS BEEN EXPLAINED TO ME, AND I HAVE HAD SUFFICIENT TIME TO ASK QUESTIONS AND RECEIVE ANSWERS. I SIGN THIS DOCUMENT VOLUNTARILY.