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Liability Waiver for a Minor Student

Parent/Guardian Information

Multi-line address

Student Information

Student Date of Birth
Month
Day
Year

Emergency Contact

Acknowledgment and Assumption of Risk

I, the undersigned parent or legal guardian of the above-named minor, acknowledge and understand that

participation in a Wilderness First Aid course involves certain risks, including but not limited to:

- Physical activity associated with CPR, bandaging, lifting, or simulated emergency response;

- Emotional stress related to emergency training scenarios; and

- Unintentional injury during hands-on practice.

I voluntarily assume all risks associated with my child’s participation in this course and certify that my child is physically fit to engage in such activities.

Release of Liability

In consideration for allowing my child to participate in this Wilderness First Aid course, I hereby release and hold harmless Wilderness Rescue Medicine LLC, its instructors, employees, volunteers, agents, and representatives from any and all liability, claims, or demands arising out of or related to my child’s participation, including any injury, illness, or property damage that may occur during the course.

This release includes any claims of negligence but does not waive rights arising from gross negligence or willful misconduct.

Medical Treatment Authorization

In the event of an injury or medical emergency, I authorize the course instructors or representatives of

Wilderness Rescue Medicine LLC to obtain emergency medical care for my child, including transportation to a hospital or urgent care facility. I understand that I am responsible for all medical expenses incurred.

Photo and Media Release (Optional)

I consent to the use of my child’s name, image, and likeness in course-related photos, videos, or promotional materials.
I consent
I do not consent

Acknowledgment and Signature

By signing below, I confirm that I have read and understood this waiver and consent form, that I am the legal parent or guardian of the participant, and that I voluntarily agree to its terms.

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