Application for Admission

Please fill out the form below.  You must be approved to take the program.
If you purchase the program and are not approved, you will receive a refund check within 15 days.

Example: I have child care restrictions. I have a bad back and can not stand for more than 4 hours.
Click or drag files to this area to upload. You can upload up to 4 files.
Allowed file formats: .doc, .xls, .ppt, .pdf, .png, .gif, .jpg

Waiver and Release Agreement

Waiver and Release Agreement In consideration of the undersigned student participating in any program offered by Health & Educational Consultants, Inc., the undersigned student hereby waives and releases any and all claims the undersigned (and other persons as provided below) may have at any time against Health & Educational Consultants, Inc.(and other persons as provided below) for any and all injuries to the person of the undersigned (including but not limited to those resulting in death) and damage to property of the undersigned, arising from any act or omission:

(1) Of any hospital or other institution in which the undersigned may engage in any instruction, practicum, or other activity pertaining to any nursing education in which Health & Educational Consultants, Inc. is involved;

(2) Of any person in any fashion employed or otherwise associated with such hospital or other institution (including but not limited to the physicians and any other members of the medical staff thereof); and

(3) Of any person who is a patient or in any fashion is in or at such hospital or other institution. The foregoing waiver and release is for the benefit of Health & Educational Consultants, Inc. and its successors and assigns, and its owners, officers, employees, and agents. The foregoing waiver and release is binding upon the undersigned and the undersigned's heirs, devisees, personal representatives, and assigns. This waiver and release has been prepared by attorneys for Health & Educational Consultants, Inc. and the undersigned has had the full right and opportunity before signing this instrument to obtain the advice of any attorney chosen by the undersigned concerning the legal effect of this instrument.

I agree to the Waiver and Release Agreement. I confirm that I am the individual as indicated herein, and consent and electronic signature confirms my approval. Please type your full name.
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