Cadaver Examination Liability Waiver

CADAVER EXAMINATION LIABILITY WAIVER

Under the direct supervision of SCL Health EMS Staff, I understand that I/my child, ______, will be viewing a prepared, dissected human anatomical specimen on ______, 2017, at: (select location)

Lutheran Medical Ctr.: 8300 West 38th Ave., Wheat Ridge, CO 80033

I/my child realize(s) that the SCL Health Cadaver Anatomy Program (the “Program”) is focused on the study of human anatomy and physiology, and that reasonable precautions will be taken to avoid any accident or injury to myself, my child and other observers as a result of participation in this educational opportunity. I/my child will at all times follow the direction and instructions of the SCL Health EMS Staff during the Program.

In the event of any accident or injury to myself, my child or other observers, I will hold SCL Health and its officers, directors, employees and representatives harmless from any and all and against any and all actions, claims and demands whatsoever, including costs, expenses and attorneys' fees, related to or arising out of the Program.

I further understand that SCL Health, including its officers, directors, employees and representatives, are not responsible for any mental, emotional or physical distress incurred by me, my child or any other observer in association with the Program.

I understand that I/my child have the option of voluntarily leaving the Program if the educational experience becomes in any way uncomfortable.

I/my child understand(s) that the following items are CONTRABAND in all SCL Health Facilities: drugs, drug paraphernalia (including marijuana, which is federally illegal), weapons of any kind, Mace/pepper spray, cigarettes, E-cigarettes. If found in my/my child’s possession, these items will be confiscated & I/my child may be escorted off campus by SCL Health Security and/or Wheat Ridge and Lafayette Police Departments. I/my child further understand(s) that smoking is not permitted on hospital grounds, even in private vehicles.

I understand that I/my child may NOT use personal electronic devices or engage in any type of reproduction of the experience, including but not limited to: cell phones, cameras, ipods, ipads, tablets, music devices, social media opportunities, audio/video-taping, etc. while engaged in cadaver anatomy lab activities. I/my child agree(s) to keep personal electronic device(s) in “off” mode and out of sight for the duration of the anatomy lab. I/my child further understand(s) that if I/my child attempt(s) to access or utilize any electronic device for any reason while in the morgue/anatomy lab area, I/my child will be escorted from the lab without permission to return or refund of tuition. In the event of a violation of the personal electronic device policy, I/my child understand(s) that my school/agency will be subject to having future anatomy lab privileges revoked.

To the best of my knowledge, I am not familiar with any family member or friend who has been a donor to the Colorado State Anatomical Board in the last two years.

Participant’s Signature: ______Parent/Guardian Signature: ______School or Agency Name:______Date: ______