Directions: Please read each section carefully, initial each acknowledgment, sign, and return this form to Center staff.

Student Responsibilities

Attendance: Students are expected to complete all online coursework and attend all scheduled classroom sessions. There are no makeup days for classroom training sessions. Failure to attend required sessions may delay or prevent program completion.

Professional Conduct: Students are expected to maintain professional behavior at all times, including punctuality, respectful communication, proper uniform, and adherence to instructor directions.

Confidentiality: Students must protect patient privacy and comply with all HIPAA and confidentiality requirements. Information obtained during training activities may not be disclosed or discussed outside approved educational settings.

LMS Participation: Students are responsible for completing all required LMS coursework and activities.

Tuition and Payment Policies: Students are responsible for payment of all tuition and fees in accordance with Center policies. Any remaining balance must be paid in full prior to program completion.

Certification Eligibility: Successful completion of all program requirements is required before the Center will provide documentation of program completion. Completion does not guarantee certification or employment.

Live Collection Activities

Participation in Laboratory Activities: I understand that participation in supervised laboratory and live collection activities is a required component of the Phlebotomy Diploma Program. Training may include venipuncture, capillary puncture, specimen collection procedures, and blood collection practice performed by and on students under instructor supervision.

Bloodborne Pathogens and Safety

I understand that phlebotomy training involves exposure to blood and other potentially infectious materials and requires compliance with infection control and safety procedures.

I understand that needles and other sharps must be handled in accordance with instructor direction and established safety procedures.

I understand that any injury, needlestick incident, blood exposure, illness, or other safety concern must be reported immediately to my instructor.

Assumption of Risk, Release, Hold Harmless, and Indemnification

I acknowledge that participation in the Phlebotomy Diploma Program involves inherent risks including venipuncture and capillary punctures, exposure to blood and other potentially infectious materials, needlestick injuries, bruising, bleeding, dizziness, allergic reactions, and other complications associated with laboratory training.

I voluntarily elect to participate in the Phlebotomy Diploma Program and knowingly assume all risks associated with participation in classroom, laboratory, clinical, and related training activities, whether known or unknown.

To the fullest extent permitted by applicable law, I hereby release, waive, discharge, and covenant not to sue CNA Training & Testing Center, LLC, their owners, employees, instructors, contractors, representatives, clinical partners, and affiliated entities (collectively, the "Released Parties") from and against any and all claims, demands, causes of action, damages, losses, liabilities, costs, or expenses arising out of or relating to my participation in the Phlebotomy Diploma Program.

I further agree to defend, indemnify, and hold harmless the Released Parties from and against any claims, demands, actions, damages, losses, liabilities, judgments, costs, and expenses, including reasonable attorney's fees, arising out of my acts, omissions, misconduct, violation of program policies, failure to follow safety procedures, or participation in program activities.

I acknowledge that CNA Training & Testing Center has provided safety instruction and supervision intended to reduce risks associated with training activities. I agree to comply with all safety requirements, instructor directions, infection control procedures, and program policies at all times.

Emergency Medical Authorization

In the event of an injury, illness, exposure incident, or medical emergency during program activities, I authorize CNA Training & Testing Center to obtain emergency medical assistance if deemed necessary. I understand that I am responsible for any costs associated with medical evaluation or treatment.

Student Acknowledgment

By signing this form, I acknowledge that I have carefully read the Program Policies, Safety Acknowledgment, Assumption of Risk, and Student Responsibilities in their entirety. I understand and agree to comply with all policies, requirements, safety procedures, assumptions of risk, releases of liability, indemnification provisions, authorizations, and student responsibilities contained in this form.

I understand that my signature constitutes my acknowledgment and agreement to all terms contained herein.