STATEMENT:
Soft Contact
lenses may constitute a potential danger in a laboratory atmosphere. They
may trap formaldehyde, acid fumes, phenol, and other substances between
the cornea and lens of the eye. The resultant damage may be irritation
to the eye or a clouding of the lenses or permanent damage to the eye.
I have been advised
of these dangers by the division chair and/or my instructor. I understand
the risk of wearing contact lenses in the lab and I choose to do so at
my own risk. I will not hold Northern Virginia Community College or its
officers responsible for any liability.
Print Name
Signature
County of Prince
William
State of Virginia
Sworn and subscribed
to before me this day
20
.
Notary Public
(SEAL)
