CERFLIT Level III Training Consent Form

Question Title

* 1. Information

Title

Full Name

Department

Email

Phone Number

Question Title

* 2. Level requested

Level III

Confirmation

Question Title

* 3. I confirm my understanding that this is a curriculum to be developed and not a course to be given as presented

I confirm

I do not confirm

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* 4. I confirm that my organization meets the criteria that are specified as required to develop and give a course in, and deliver the course safely in my organization.

I confirm

I do not confirm

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* 5. I confirm that in requesting and receiving this course, the CAFC has made no endorsement, verification or statement about my organization’s capacity to deliver this training safely

I confirm

I do not confirm

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* 6. I confirm that my organization will assume all responsibility for the safe delivery of any course developed with this material and that CAFC will hold no responsibility

I confirm

I do not confirm

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* 7. I confirm that my organization will provide a debrief on the use of the requested material within 1 year of receipt to the CAFC

I confirm

I do not confirm