Advanced Rescue Training & Attendance Record Rope Access for Windows (RAW BEST)

ONTARIO WINDOW CLEANERS ASSOCIATION WITH ADVANCED RESCUE TRAINING RECORD
Liability Release and Medical Declaration Form

This is an activity registration form, training record and waiver.
RESCUE | EMERGENCIES | DISASTERS | MEDICAL | SAFETY

THIS IS AN OFFICIAL COURSE REGISTRATION & WAIVER.

1. Take a passport style photo on your phone with white background
2. Take a photo on your phone of their Driving License.

OPEN THIS HEADSHOT TIPS LINK

This waiver must be fully completed by all participants. It also forms the basis of proof of your training.

Any issues or matters we should know about please put in the comments below.

LIABILITY RELEASE

I hereby acknowledge that I am aware of the risks to which I may be exposed during activities, with potential minor and major accidents that may cause me or other person’s bodily harm and/or illness.

SAFETY TO MYSELF, SOPS & PPE

I fully understand and accept that Advanced Rescue by DIMERSAR (ARD) , as well as connected agencies; the course coordinator, instructors and assistant personnel, have taken every precaution possible to prevent accidents, injuries and illness during these activities and it is important that I participate in this as a constructive participant (i.e., wearing PPE, following SOPS / Safety standards, not freelancing in a dangerous manner, etc.) I agree to comply with safety standards and will ensure my own safety and the safety of all others to the best of my ability.

SAFETY TO OTHERS

I will not recklessly endanger myself or other participants and in the event of any accident that may cause me bodily injury or illness during, I do release ARD as well as course providers, activities partners, (i.e., Advanced Rescue by DIMERSAR), coordinator, instructors, assistant personnel, from legal liability thereof.

MEDICAL CONDITIONS & DECLARATION

I am aware this is performed in varied environments, requiring physical exertion and may be very tiring and strenuous. I understand and am aware of the Fitness and Medical requirements and will not overextend myself and declare any medical issues.

FITNESS DECLARATION

I understand operational members need a good basic level of fitness and this may be tested regularly. I am fit enough to perform the fitness tests, active tasks pertaining to the expected requirements of the course including the carriage and use of equipment and will not hold ARDet al responsible. I will advise if I feel unfit or unwell and not leave without informing a person in authority that I intend to do so. I also acknowledge I will inform ARD of any fitness or medical / mobility issues I may have.

AGREEMENT TO RECEIVE ELECTRONIC & OTHER COMMUNICATION
We may have to send you information by mail, electronic or other means. We would like your agreement to do so. We emphasise this is necessary and we do NOT share your contact details and this will cease if you leave. Please maintain your up to date contact details with us.

MEDIA USE & RELEASE

From from time to time, the sessions are filmed, recorded, photographed and I acknowledge and agree to said filming, taping etc. and allow my image / recording to be included freely as needed including on websites, documents, manuals, news releases, etc.

Signee Information

First Name *

Last Name *

Your Date of Birth *

Phone *

Email Address *

Confirm Email Address *

---------- || ADDRESS

Please give us your full address where we can write to you if necessary.

Your Postal Address *

Please provide number / name and street

Address Line 2

Optional Second Line (i.e., Unit, Apartment or Flat Number)

Town / City*

Please write your Town / City

County or Province (State US)*

County / Province

Postal Code *

Please write your Post Code (Zip Code for US)

COUNTRY*

Address Country

---------- || EMPLOYMENT ACTIVITIES

Please let us know what you do for a living.

EMPLOYMENT / DAILY ACTIVITIES*

Please put your role or anything you you do professionally for work or a routine basis. (Examples; Paramedic, Police Officer, Managing Director, Business Owner - Plumber, Full Time Homemaker, etc.)

EMPLOYER*

Please put your Employer or who you work for or the industry.

USEFUL TRAINING & QUALIFICATIONS*

Please take a moment to write some information on yourself, your background and training which will help promote yourself.

---------- || SIZING

We would like your size in case we need to lend you a harness or other kit. We can get this information later but your T-shirt or Jacket size would be useful (S,M,L, XL, etc).

Your jacket size and height *

For harness sizing if required

---------- || MEDICAL CONDITION & ANY ALLERGIES

Please state any information we should know especially if you have an aversion or phobia to heights.

MEDICAL CONDITIONS

Please list any chronic injuries you are managing, or Medical Conditions? e.g. Asthma. (If NONE, state "None.")

ALLERGIES

Please list any allergies or drugs allergies? e.g. Peanut Butter or Penicillin If none state "None."

---------- || ATTACHMENTS / UPLOADS

Please add photo headshot and your ID verification.

ATTACHMENT UPLOADS

Please add your photos and proof of ID 1. HEADSHOT There headshot should be a clear recent photo of you, front facing (not side) and head and shoulders. No sunglasses and no hat please. (Please think like a smart PASSPORT PHOTO style.) 2. ID VERIFICATION Please upload a clear photo of your driver's license for Proof of ID. It should clearly show your name as we know it (and if the name is different an explanation why.) You may use a Passport if you do not have a Drivers License. Finally, if you have a Criminal Records / Background check, please feel free to email that to us too.

ADDITIONAL COMMENTS *

Please feel free to add anything here about your training, experience, interest or comments here. Thank you

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Attachments

Your Passport style headshot Photo *

We need a headshot for your form and possible training and ID cards. (Passport style photos are best. No one else in the photo. Photos taken now on your phone can be used. Clean background please.)

Proof of ID *

We need to verify the identification of those attending. A drivers license or passport is acceptable.

Sign Here

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.