Escape Room Consent Form

Gather permission from students and families to take part in a school escape room activity, along with academic and contact details. Student and guardian signatures are included.

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Name

Nombre

Apellido

Email

Cell phone

School you attend

Grade you are currently in

Student's date of birth

Student citizenship status

I need the most help with

I want to go on this trip because

I want to have fun with friends I want to learn something new I'm interested in science and technology My teacher recommended it Other reason

Career I am interested in

Student signature: I have read, understood, and accept the informed consent and assumption of risk

Sign here

Parent or guardian name

Nombre

Apellido

List any allergies (food, bees, etc.)

Parent or guardian phone number

Parent email address

Parent 1 highest education completed

Parent 2 highest education completed

Household taxable income

Household income is

Parent permission and signature: I confirm I have read, understood, and accept the informed consent and assumption of risk

Sign here

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