IMG-EA

EXHIBIT

ANIMALS  IN  SCHOOLS

ANIMALS IN CLASSROOM
STUDENT PERMISSION FORM

Student Name: _________________________________________________________

Classroom: ____________________________________________________________

Animal(s): _____________________________________________________________

From (Date) _______________________       Until (Date): _______________________

Is your child (circle one for each):

Allergic to animal(s) mention above?                  Yes       No

Frightened by animal(s) mentioned above?        Yes       No

May your child (circle one for each):

Handle the animal(s) mention above?                 Yes       No

Take care of the animal(s) mentioned above?     Yes       No
   (Clean cage and feed)

Remarks:  _____________________________________________________________

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_________________________________________          ________________________
              Signature of Parent or Guardian                                               Date