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Comfort Paradise Training Institute's Student Attestation, Photographs waivers, and Release Form
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Today's Date *
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This will certify that I, and no one else, will complete the Live Distance Education course known as: *
Required
The course is approved for _______ hours of Californian State  education credit. *
60 hours Theory
100 Clinicals
Combined Response
The course will be completed on: *
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Student Name (First name, Last Name) *
Student Email *
Student's Phone Number *
Student Mailing Address: Street Address *
City *
State *
Zip Code *
ID/ Driver's License Number: *
I certify under penalty of perjury and false swearing that I am the student who took the above course and that this typed signature has the same legal effect and can be enforced in the same way as a written signature. Please Enter Name or Signature to sign. *
I, ________________________________, CONSENT AND GIVE PERMISSION TO "Comfort Paradise Training Institute” to photograph my Nurse Assistant Training. I understand that any such photographs, and all rights associated with them, will belong solely and exclusively TO “Comfort Paradise Training Institute”, which shall have the absolute right to copyright, duplicate, reproduce, alter, display, distribute, and/or publish them in any manner, for any purpose, and in any form including, but not limited to: print, electronic, video, and/or internet.  I voluntarily waive any and all rights with respect to any such photographs, including compensation, copyright, and privacy rights and any right to inspect or approve such photographs and/or copy, print or other materials that may be used in connection with them. I hereby release and discharge, and agree to hold harmless, Assured and Associates, its officers, agents and employees, and all persons acting under its permission or authority, from any TO “Comfort Paradise Training Institute” claims and liability in connection with such photographs and/or their use. *
I HAVE READ AND FULLY UNDERSTAND THE CONTENTS OF THIS CONSENT, WAIVER, AND RELEASE FORM, AND I SIGN IT FREELY AND VOLUNTARILY. Student's Full Names (First, Last) *
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