Gymnema Sylvestre Taste Lab Permission Slip Student Name (Print)

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AP Psychology Southmoore High School Miracle Berry/ Gymnema Sylvestre Taste Lab Permission Slip Student Name (print) ____________________________________ Grade_________________ Parent Permission: I give my son/daughter permission to participate in the Miracle Berry Taste Lab in AP Psychology class at Southmoore High School. I understand that this lab involves consuming a “miracle berry” or Gymnema Sylvestre followed by tasting very small amounts of various food, seasonings, and beverages. I understand that the school is not liable for any allergic reactions my child has to any of the involved substances involved in the lab including: miracle berries, salt, sugar, lemon, coffee, vinegar, beef broth, potato chips, cookies, seasonings, and/or pickles,. This permission slip is due (signed by a parent or guardian) on the day of the lab or participation in the lab is not allowed. Important information A signed parent permission slip is mandatory for participation in the lab This lab will be supervised by Ms. Blevins in a safe and clean environment “Miracle berries” are tabs of freeze dried fruit (“miracle fruit” aka Synsepalum dulcificum) The berries have a low sugar content and a molecule called “miraculin” which when bound to the tongue’s taste buds cause sour foods to taste sweet, and alters other flavors as well Gymnema Sylvestre is a woody climbing shrub most often, today, consumed as a tea or in pill form. Gymnema Sylvestre is used to prevent the absorption of sugar and when used to coat the inside of the mouth can cause sweet foods to have no flavor. Gymnema Sylvestre might lower blood sugar Parent/Guardian Information Please Print: ___________________________________________________________ Parent/Guardian Signature_______________________________________________ Date: _____________________ Parent Contact Phone Number(s) _____________________________ Emergency Contact Information Name (print)__________________________________ Relation_______________________________ Phone number___________________________________ .

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