3. Medical Program Acknowledgement of Responsibility
DON'T TYPE INSIDE THIS BOX hereby acknowledge that I have been fully advised that my program of study requires performing venipuncture, capillary sticks and numerous laboratory test. I further acknowledge my responsibility to only perform the above activities and test under direct supervision of my site supervisor. I further agree to hold Keiser University and
DON'T TYPE INSIDE THIS BOX harmless for any and all consequences (including transmission of blood borne pathogens) of such participation which are not the fault nor with control of Keiser University and the prior mentioned Training Site.
Applicant Name/Electronic SignatureBy typing your name you have created an electronic signature as legally binding as your handwritten signature.
Parent or GuardianBy typing your name you have created an electronic signature as legally binding as your handwritten signature.
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