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PVCC Workforce Services
PVCC Workforce Services
| ACKNOWLEDGEMENT OF RISK FORM I agree to abide by any and all specific requests by the College and the instructional site/lab/clinical facility for my safety or the safety of others, as well as any and all of the College’s and the instructional site/lab/clinical facility’s rules and policies applicable to all activities related to this program. I understand that the College and the instructional site/lab/clinical facility reserve the right to exclude my participation in this program if my participation or behavior is deemed detrimental to the safety or welfare of others. In consideration for being permitted to participate in this program, and because I have agreed to assume the risks involved, I hereby agree that I am responsible for any resulting personal injury or illness which may occur as a result of my participation or arising out of my participation in this program, unless any such personal injury or illness is directly due to the negligence of the College and/or the instructional site/lab/clinical facility. I understand that this Acknowledgement of Risk form will remain in effect during any of my subsequent visits and program-related activities, unless a specific revocation of this document is filed in writing with Dean of Workforce Services, at which time my visits to or participation in the program will cease. I understand that I have the option to postpone any clinical placement or on-campus assignment without academic penalty. I also understand that I must complete the requisite number of clinical hours or other requirements to complete the health professional or other academic program in which I am enrolled. If I choose to postpone any clinical placement or on-campus assignment, I understand that my progression within the health professional or other academic program will be delayed. I acknowledge that I have read and fully understand this document. I further acknowledge that I am accepting these personal risks and conditions of my own free will. I represent that I am 18 years of age or older and legally capable of entering into this agreement. If participant is less than 18 years of age, the following section must be completed: My child/ward is under 18 years of age, and I am hereby providing permission for him/her to participate in this program. I agree to be responsible for his/her behavior and safety during this event. __(See Below)____ Child’s Name ____(Complete Address Below)___ Address __(Sign Below)____ Parent or guardian signature | |
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PVCC Workforce Services
