Solar Eclipse: Viewing Information AND Westside Consent/Release Form
Participation in viewing is completely optional and voluntary. Students are not required to participate in this Westside Community Schools viewing experience. However, should a parent/guardian decide to allow their student to participate, all items below marked with a red "*" like the one immediately below this statement are required.
Please click on the following link to view the PDF file containing important eclipse information.
I wish for my child to participate in activities related to the viewing of the solar eclipse on August 21, 2017. I understand that participation is not required, that I am free to decide not to give consent, and that alternate educational activities will be available for students who do not participate in the viewing.
I am aware of the risks inherent in viewing a solar eclipse if special viewing glasses are not used or if they are used improperly:
Solar retinopathy is a result of too much ultraviolet light flooding the retina. In extreme cases this can cause blindness, but is so painful that it is rare for someone to be able to stare at the sun for that long. Typically, eye damage from staring at the sun results in blurred vision, dark or yellow spots, pain in bright light or loss of vision in the center of the eye (the fovea). Permanent damage to the retina has been shown to occur in approximately 100 seconds, but the exact time before damage occurs will vary with the intensity of the sun on a particular day and with how much the viewer's pupil is dilated from decongestants and other drugs they may be taking. Even when 99% of the Sun's surface (the photosphere) is obscured during the partial phases of a solar eclipse, the remaining crescent Sun is still intense enough to cause a retinal burn. Note, there are no pain receptors in the retina so your retina can be damaged even before you realize it, and by then it is too late to save your vision!
With full awareness of these risks, I hereby give consent for my child to participate in this school eclipse viewing activity using eclipse-safe viewing glasses.
In consideration of the District allowing my child to participate in viewing the solar eclipse, I certify to Westside that my child will follow all directions from Westside staff on viewing procedures and will not attempt to look at the eclipse without the special viewing glasses. I accept responsibility for any loss, damage, or injury to my child that occurs during or in connection with viewing the solar eclipse.
I agree to release Westside Community Schools, its Board of Education, the members of the Board of Education individually, the employees and agents of the District, and the Westside Foundation, and hold each harmless from any injury or damages which may be caused to my child in connection with my child’s viewing of the solar eclipse on August 21, 2017.
Enter Your Student's First Name(Required): *
Your answer
Enter Your Student's Last Name(Required): *
Your answer
Choose Your Student's Grade Level(Required): *
Choose Your Student's Building(Required): *
A Parent/Guardian should type their full name below. NOTE: This typed name and the act of clicking the SUBMIT button below serves as a signature indicating informed consent and indicates agreement to the terms and conditions listed above(Required for participation). *
Your answer
Never submit passwords through Google Forms.
This form was created inside of Westside Community Schools. Report Abuse - Terms of Service - Additional Terms