Study Room Statement of Responsibility

Please read the Study Room Statement of Responsibility before submitting this form.

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Signature Signature First Last
Date Date / MM / DD YYYY
CWID
Phone Phone - ### - ### ####
I have read the Study Room Statement of Responsibility and fully understand its terms and my obligations. I understand that this document is contractual in nature and my signature above indicates my agreement with the terms as stated.

I have read the Study Room Statement of Responsibility and fully understand its terms and my obligations. I understand that this document is contractual in nature and my signature above indicates my agreement with the terms as stated. I agree to the terms listed in the Study Room Statement of Responsibility.