CLASS REGISTRATION FORM

I have read this release *

And I understand it.

Email - (if 18) or Parent/Legal Guardian *

KITTITAS COUNTY EMS DIVISION
RELEASE AND HOLD HARMLESS AGREEMENT

There are risks and dangers inherent when participating in emergency care training classes. These risks include, but are not limited to, injuries during skills practices; back injuries from moving a simulated victim; acquiring communicable diseases; or performing skills on fellow students.

Neither American Safety and Health Institute, Inc. (“ASHI”) nor Kittitas County EMS Division (“KCEMS”) can guarantee the safety of participants, but Training Center’s authorized and affiliated instructors are trained to take reasonable precautions to minimize risks and safeguard participants’ health and safety during training, including:

Providing each class participant with sanitary personal protective equipment, including, but not limited to, breathing barriers (face shields/masks), gloves, and eye protection.

Providing training manikins to practice skills such as chest compressions, abdominal thrusts, and rescue breathing that are not appropriate for student-on-student practice.

In addition, instructors and participants should avoid awkward or extreme body positions to avoid back or other injuries from improper lifting and moving. Instructors and participants should not practice moving simulated victims if they have a history of back problems because such practice may aggravate previous back injuries.

Choose *

FA/CPR Class (PUBLIC)

FA/CPR Class (Emergency Response Agency)

Adult Only CPR/AED & Stop the Bleed

Child and Babysitting Safety Class

Cell Phone - (if 18) or Parent/Legal Guardian *

Class Registration/RELEASE AND HOLD HARMLESS AGREEMENT *

I assume the risks inherent in this class.

Name of Agency and Department (if applicable)

I reviewed, understand, and agree *

This release applies to personal injury, including death, and property damage which I may suffer.

Voluntarily Release *

I hereby voluntarily release and hold ASHI and KCEMS, and each of their instructors, employees and volunteers, harmless from any and all liability or costs from injury associated with or arising from my participation in this class, including from negligence.

Name of Parent/Legal Guardian (if participant is under age of 18)

PARTICIPANT NAME (electronic signature) *

I understand, and agree *

This release will be binding on me, my spouse, my heirs, my personal representatives, my assigns, my children, and any guardian appointed by the court for said children.