VIERA Registration and Consent Form - EMALB

Consent to Release Information to EMALB

I hereby consent to allowing Vancouver Island Emergency Response Academy (VIERA) to release the following information to BC Emergency Medical Assistant Licensing Board – for the purpose of being registered as a qualified VIERA First Responder Instructor/Evaluator:

Consent to the above statement

Consent to Release Information to Employer

I hereby consent to allowing Vancouver Island Emergency Response Academy to release to my employer my test results, Statement or Certificate of Course Completion and verification of attendance in connection with this course. I understand that my consent is required prior to release of the specified information.

Consent to the above statement

Emergency Contact Information

 

 

Collection and use of your personal information
Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA), and is protected in accordance with FOIPPA.  Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose. Questions about the collection of your personal information may be referred to the Legislative Services Department at (250) 755-4405, or via email at foi@nanaimo.ca.
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Last updated: September 16, 2019

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Collection and use of your personal information
Information collected on this form is done so under the general authority of the Community Charter and Freedom of Information and Protection of Privacy Act (FOIPPA), and is protected in accordance with FOIPPA.  Personal information will only be used by authorized staff to fulfill the purpose for which it was originally collected, or for a use consistent with that purpose. Questions about the collection of your personal information may be referred to the Legislative Services Department at (250) 755-4405, or via email at foi@nanaimo.ca.
Privacy Policy