Student/Observer Confidentiality Agreement & Liability Waiver

Confidentiality Agreement & Liability Waiver For Students/Observers

McDowell County Emergency Services
Student/Observer Information
Student/Observer Name

First NameLast Name
Date Of Birth

MonthDayYear
Phone Number
Format: (000) 000-0000.
Student/Observer Email
example@example.com
Institution

Other
Emergency Contact Details

In case of emergency, we will contact the person below:
Emergency Contact Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Relationship
Confidentiality Agreement for Students and Observers
This Confidentiality Agreement ("Agreement") is entered into by and between [Student/Observer Name] and McDowell County Emergency Services ("EMS/911 Center") on this date: [Date of Signature].

1. Confidential Information

For the purposes of this Agreement, "Confidential Information" includes all information, data, and materials, whether written, oral, or otherwise, disclosed to the Student/Observer during their observation or participation in EMS/911 Center activities. This includes, but is not limited to, patient information, operational procedures, proprietary data, and any other information designated as confidential by the EMS/911 Center.

2. Obligations of Confidentiality

The Student/Observer agrees to:

Maintain the confidentiality of all Confidential Information.
Not disclose Confidential Information to any third party without the prior written consent of the EMS/911 Center.
Use Confidential Information solely for the purpose of observing or participating in EMS/911 Center activities.
Take all necessary precautions to prevent unauthorized access, use, or disclosure of Confidential Information.

3. Term and Termination

This Agreement shall remain in effect for the duration of the Student/Observer's participation in EMS/911 Center activities and for a period of two (2) years thereafter. The obligations of confidentiality shall survive the termination of this Agreement.

4. Return of Materials

Upon termination of this Agreement or at any time upon request by the EMS/911 Center, the Student/Observer shall promptly return all materials containing Confidential Information to the EMS/911 Center.

5. Governing Law

This Agreement shall be governed by and construed in accordance with the laws of North Carolina.

6. Acknowledgment

The Student/Observer acknowledges that they have read, understand, and agree to the terms and conditions of this Agreement.
Student/Observer Signature
Date of Signature

MonthDayYear
Liability Waiver for Students and Observers
This Liability Waiver ("Waiver") is executed by [Student/Observer Name] in favor of McDowell County Emergency Services ("EMS/911 Center"), its directors, officers, employees, and agents.

1. Assumption of Risk

The Student/Observer acknowledges and understands that participation in EMS/911 Center activities involves certain inherent risks, including but not limited to exposure to emergency situations, hazardous environments, and potential physical harm. The Student/Observer voluntarily assumes all risks associated with their participation in these activities.

2. Waiver and Release

The Student/Observer, on behalf of themselves, their heirs, executors, administrators, and assigns, hereby releases and forever discharges the EMS/911 Center, its directors, officers, employees, and agents from any and all claims, demands, causes of action, or liabilities of any kind, whether known or unknown, arising out of or in any way related to the Student/Observer's participation in EMS/911 Center activities.

3. Indemnification

The Student/Observer agrees to indemnify and hold harmless the EMS/911 Center, its directors, officers, employees, and agents from any and all claims, demands, causes of action, or liabilities of any kind, whether known or unknown, arising out of or in any way related to the Student/Observer's participation in EMS/911 Center activities.

4. Medical Treatment

The Student/Observer consents to receive medical treatment in the event of injury, accident, or illness during their participation in EMS/911 Center activities. The Student/Observer releases the EMS/911 Center from any claims arising out of or in connection with such medical treatment.

5. Governing Law

This Waiver shall be governed by and construed in accordance with the laws of North Carolina.

6. Acknowledgment

The Student/Observer acknowledges that they have read, understand, and agree to the terms and conditions of this Waiver. The Student/Observer further acknowledges that they are signing this Waiver voluntarily and that no oral representations, statements, or inducements apart from the foregoing written agreement have been made.
Please Confirm Student/Observer Age
Student/Observer Signature
Date of Signature

MonthDayYear
Parent/Legal Guardian Information

If the Student/Observer is under the age of 18, this Waiver must be signed by a parent or legal guardian.I, [Parent/Guardian Name], am the parent or legal guardian of [Student/Observer Name], a minor, and I hereby agree to the terms and conditions of this Waiver on behalf of the minor. I further agree to release, indemnify, and hold harmless the EMS/911 Center, its directors, officers, employees, and agents from any and all claims, demands, causes of action, or liabilities of any kind, whether known or unknown, arising out of or in any way related to the minor's participation in EMS/911 Center activities.
Parent/Legal Guardian Name

First NameLast Name
Parent/Legal Guardian Email
example@example.com
Parent/Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Legal Guardian Signature
Date of Signature

MonthDayYear
Should be Empty:

Confidentiality Agreement & Liability Waiver For Students/Observers

Student/Observer Information

Emergency Contact Details

Confidentiality Agreement for Students and Observers

Liability Waiver for Students and Observers

Parent/Legal Guardian Information