Informed Consent: By my signature below, I understand and agree as follows:
I have read the information provided in this form and had the opportunity to ask any questions I have.
I am providing my informed consent for the Student Volunteer named below to participate as a volunteer in the Program, by permitting a NEMI Student to take a blood draw from the Student Volunteer under the direct and close supervision of a Program instructor.
The Student Volunteer named below has no medical conditions that would be adversely impacted by his/her volunteer participation in the Program.
Waiver of Liability and Release of Claims: By my signature below, I understand and agree as follows:
I voluntarily assume any and all risks relating to the Student Volunteer's participation as a Student Volunteer in the Program.
I, my heirs, assigns and representatives hereby release, waive, discharge, hold harmless, defend and indemnify NEMI and/or the Program, their officers, agents, volunteers, and employees from any and all liability, claims, demands, damages, fees or expenses, or actions whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by the Student Volunteer as a result of the Student Volunteer's participation in the Program.
The Program cannot be expected to control all of the risks associated with this Program and that there may be the need for a response to accidents and potential emergencies. Therefore, I give my consent for any medical treatment that may be required as determined by a medical professional during the Student Volunteer's participation as a volunteer in the Program, with the understanding that I will be financially responsible for all costs of treatment.
I have read this Consent and Waiver and Release of Liability form, understand it and signit voluntarily.