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

 

 

Last updated: September 16, 2019

Help us improve our website

Don't include private or financial information in this form.