To be used when animal(s) are brought into the classroom or learning center for educational purposes.
As allergies, asthma, immune problems, and/or other health concerns may make animal contact inappropriate for some students, District guidelines require prior parent/guardian permission for student contact with animal(s) in school.
On __________________(insert date), the following animal(s) will visit my classroom for educational purposes: (circle all that apply)
Cat Bird Ferret Guinea Pig
Dog Rabbit Hamster Reptile or amphibian
Rat Mouse Gerbil Other
The following animals are prohibited in schools: venomous or toxin-producing animals (e.g., certain spiders, insects, reptiles, and amphibians), wild or exotic animals, mammals at high-risk for transmitting rabies (e.g., bats, raccoons, skunks, foxes, and coyotes), non-human primates, stray animals, or aggressive/unpredictable animals.
The Building Principal or designee will ensure that the District’s Guidelines for Using Animals in School Facilities are followed. You may find these Guidelines in the school office. I will also supervise the entire student-animal contact session, have a clean and disinfected area for showing the animal(s), not allow food or drink in the animal showing area, and appropriately dispose of animal waste. Under no circumstances are students allowed to clean cages or handle animal waste.
Please complete and return this form to me by (insert date). If you have any questions or concerns, please feel free to contact me at (insert contact information).
To Be Completed by Parent/Guardian:
_____ I do permit my student identified above to be exposed to the animal(s) listed above. I further agree to indemnify and hold harmless the School District and its employees and agents against any claims, except a claim based on willful and wanton conduct, arising out of my student’s exposure to the animal(s) listed above.
_____ I do not permit my student identified above to be exposed to the animal(s) listed above. I understand that when the animal(s) listed above are present, my student will be excused from classroom attendance without penalty and given an alternative educational activity.
Parent/Guardian Name (please print)
Parent/Guardian Signature Date
Date Adopted: October 4, 2016