Emergency Training Consent Form

EMERGENCY TRAINING CONSENT FORM

Purpose: This form documents consent to participate in emergency preparedness and response training provided or authorized by the educational institution. Training may include, but is not limited to, first aid, cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, evacuation procedures, lockdown procedures, and other emergency response drills. Participation may involve physical activity and simulated emergency scenarios. Please complete all sections and sign where indicated.

Student Information

Student Name:

Date of Birth:     Student ID:

Parent / Guardian Information (if student is minor)

Student is under 18 years of age:

Training Details

Type(s) of Training (check all that apply):
CPR AED First Aid Evacuation Drill Lockdown Procedure Other:

Scheduled Date(s):     Location:

Estimated Duration:

Medical Information & Accommodations

Emergency Contact & Insurance

Consent, Authorizations, and Acknowledgements

Assumption of Risk: I acknowledge that participation in emergency response training may involve physical exertion and simulated emergency conditions that carry a risk of injury. I voluntarily assume all risks associated with participation, whether known or unknown, foreseeable or unforeseeable.

Consent to Participate and Emergency Treatment Authorization: I authorize the student named above to participate in the training described on this form. In the event of an injury or medical emergency during training, I authorize school representatives or training providers to obtain emergency medical care for the student and to share pertinent medical information with treating professionals. I agree to be responsible for any costs of treatment not covered by insurance.

Release and Indemnity: To the fullest extent permitted by law, I release and hold harmless the educational institution, its employees, volunteers, and agents from liability for injury, death, or loss arising from participation in the training except for willful misconduct or gross negligence. I agree to indemnify the institution for claims arising from my failure to disclose medical conditions or follow reasonable safety instructions.

Photo/Video Recording: I understand that portions of the training may be recorded for training, documentation, or safety review purposes. I consent to the use of images or recordings of the student for institutional training and safety purposes unless I decline by checking the box below.
I opt out of photo/video use for the student

Confidentiality of Health Information: The institution may disclose health information about the student to trainers, emergency responders, and medical personnel as necessary for health and safety. Such disclosures will be limited to the minimum necessary to address the emergency or training need.

Compliance with Safety Instructions: I understand that compliance with instructor and institutional safety instructions is required. Failure to follow instructions may result in removal from training and notification to parent/guardian or institution officials.

Acknowledgment

I certify that the information provided on this form is true and complete to the best of my knowledge. I have read and understand the statements above and provide my informed consent and authorization as indicated by my signature below.

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