I understand
that there are possible dangers to an unborn fetus from chemicals used
in a science Laboratory.
This is to certify
that I have been advised of these dangers by the Environmental and Natural
Science division chairman and/or my instructor. I understand the risk of
remaining in the laboratory while pregnant 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)
