In connection with the ACEEAA Course sponsored by the Academy of Geriatric Physical Therapy, I hereby volunteer for and consent to perform and have performed on me physical therapy tests and measurements for aging adults in the following examination categories:
- I understand that there are minimal risks associated with these tests and measures.
- I understand that these tests and measurements are being performed for the sole purpose of demonstration and that they are not intended to be diagnostic or therapeutic for me personally.
I recognize that the persons providing and/or performing the tests and measurements will answer any inquiries I may have and that I am free to withdraw my consent and discontinue participation at any time.
- I hereby release the Academy of Geriatric Physical Therapy and and its directors, employees, and agents from any and all liability, loss or damage arising from or in any way connected to the tests and measurements identified above.
- I have read this Consent and Release and understand its contents.
- I affirm that I have fully and accurately answered all questions about my health asked by the individuals conducting the CEEAA Courses and that I have disclosed all information concerning my health that is relevant to my participation in the CEEAA Courses.
- I grant to the Academy of Geriatric Physical Therapy, its representatives and employees the right to take photographs of me and my property in connection with the CEEAA Course Series and other educational programs. I understand that this material may be used in diverse educational settings and formats (online, in print, in person) within an unrestricted geographic area