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The Tactical EMS School ApplicationFloatingAx2023-04-06T04:37:48-05:00

September 24-29, 2023 at Camp Ripley, Minnesota

More Information: www.tactical-specialties.com

PARTICIPANT INFORMATION FORM: PLEASE ENTER INFO

Physical Readiness Statement and Physician’s Assessment

1. Any chronic or recurrent illness?
2. Any illness lasting more than a week?
3. Any hospitalizations?
4. Any surgery?
5. Any injury requiring treatment by a physician?
6. Is your blood pressure above 120/70? What is your normal BP?
7. Any cardiac problems including heart murmur?
8. Any recurring bleeding problems?
9. Any dizziness, fainting, convulsions or frequent headaches?
10. Ever been knocked out or had a concussion?
11. Ever had hepatitis, mononucleosis, diabetes or asthma? (circle all relevant)
12. Ever had difficulty breathing?
13. Any history of tuberculosis or positive skin test; any reason for a chest x-ray?
14. Wear any dental appliances such as braces, bridges or plates?
15. Any knee or ankle injuries?
16. Any family history of sudden death?
17. Any hearing problems?
18. Any history of neck injury?
19. Any other joint sprains or dislocations? (shoulder, wrist, finger, etc.)
20. Any broken bones, (fractures)?
21. Any organs missing other than tonsils? (appendix, eye, kidney, etc.)
22. Any heat exhaustion or stroke?
23. Any cold injuries? (frostbite, significant hypothermia)
24. Have you traveled outside of the U.S. in the past 6 months?
25. Are you currently following a carbohydrate restricted diet or any other significant dieting regimen?
Do you carry an epi-pen?
If you were seriously injured, would the presence of clergy be of benefit to you?

RELEASE OF LIABILITY & ASSUMPTION OF RISK AGREEMENT

IN CONSIDERATION of being permitted to participate in any way in the training and instruction being offered by Tactical Training Specialties, Inc., I, THE RELEASOR, acknowledge, appreciate, and agree that:

  1. This training program involves simulated, full contact self-defense situations and/or the use and discharge of less-lethal projectile training weapons (e.g., Simunitions ®, AirSoft ®, and paint guns), and traditional weapons and/or firearms by the class members and instructors. Such weapons will be used in various situations and locations. I am fully aware of the inherent risk of injury associated with the activities and equipment involved with such training and instruction, including the potential for permanent disability and death, and while protective equipment and personal discipline will minimize this risk, the risk of serious injury does exist;
  2. I knowingly and freely assume all such risks, even if arising from the negligence of those persons released from liability below, and assume all responsibility for my participation in said training and instruction; and
  3. I understand that this training program is physically and mentally intense. I understand that I must always follow the instructions of all training cadre and instructional staff/personnel. If I observe any unusual or unnecessary hazards during my participation, I will bring such to the attention of the training staff as soon as practical; and
  4. I, for myself and on behalf of my heirs, assigns, next of kin and personal representatives hereby fully release and agree to hold harmless Tactical Training Specialties, Inc., its directors, officers, employees, agents and subcontractors, including the owners and lessors of the premises used to conduct the Tactical EMS School including their officers, employees, instructors, agents and subcontractors (collectively hereinafter referred to as “releasees”) from any and all claims of whatsoever kind arising from any damages, injury or death or other loss I may sustain while participating in the Tactical EMS School whether such loss is caused in whole or in part by any act or omission of releasees. I expressly, and specifically, assume all risks of participation in all or any part of the Tactical EMS School including any risks of attending any events in which I do not participate.
  5. I understand and agree that this RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT covers each training session and/or simulation in which I participate or attend.
  6. I have read and fully understand this Release of Liability and Assumption of Risk Agreement. I understand the contents and that I have a right to have this Agreement reviewed by an attorney at my own expense. I fully understand and agree that by signing my name below I am giving up important legal rights, and I freely, knowingly and expressly agree to the terms of this Agreement.

The Tactical EMS School - Tactical Training Specialties
The Essentials of Tactical EMS
Conducted at Camp Ripley, Minnesota

For valuable consideration, receipt of which is hereby confessed and acknowledged, I do hereby give and grant unto The Tactical EMS School, its successors and assigns, and those acting under it, including Tactical Training Specialties, full and complete permission to use my name, title, photograph and/or photographic likeness, for use in any and all Tactical Training Specialties advertising and marketing purposes, internal and external, and in any or all media, whether now known or hereafter existing/devised, in perpetuity.

I do hereby further certify that I am of full age and I possess full legal capacity to execute the foregoing authorization and release, which is hereby made binding upon my heirs, assignees, next of kin, and personal representatives.

  1. Completed and legible Participant Information form (write your e-mail address LEGIBLY!)
  2. Signed Physician’s Assessment form with complete contact information (click here for link)
  3. Medical Information form completed by applicant.
  4. Liability and Assumption of Risk form signed by applicant.
  5. Consent to Use Name and Photographic Likeness.
  6. Letter of Reference/Recommendation on department letterhead (e-mail separately)
  7. Payment of $1,950. Payment must be made by check or money order. No credit cards.

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