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Minor Consent Form

Please fill out this form if your minor will be attending a CPR course at One Life CPR. Your cooperation is essential for ensuring a smooth registration process and a safe learning environment for all participants. Thank you for your attention to this important matter.

Child's First name*

Child's Last name*

Child's First Name (2)

Child's Last Name (2)

Child's First Name (3)

Child's Last Name (3)

Child's Age*

Child's Age (2)

Child's Age (3)

Parent's First Name*

Parent's Last Name*

Phone Number*

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Emergency Contact*

Does your child have any food or latex allergies? If YES, please explain*

My plans during my child's class is*

Other Adults authorized to pick up your child (First/Last Name and relation to child)*

In the event of an emergency, One Life CPR, LLC will contact Emergency Medical Services.*

Agree

We ask an authorized adult to pick up and drop off the minor directly to and from the classroom.*

Agree

For any of the full day classes, I will make sure my child has a drink, snacks, or lunch with them. *

Agree

We ask if the student has had recent flu like symptoms to contact us to reschedule in order to keep everyone safe.*

Agree

One Life CPR may use manikins for some of the rescue skills. These manikins require strict standards for controlling infection. I agree to not send my child if he/she has a contagious illness including a rash. *

Agree

I give permission for my child to practice on the manikins. *

Agree

The Instructor reserves the right to decline the application of any student, or send home any student who, according to the sites discretion, is disruptive or puts him/herself or others at risk. *

Agree

I, the undersigned, consent to the use, reproduction and publication of One Life CPR, LLC of pictures or recordings taken of my child during the program for publicity purposes.*

Agree

Acknowledgement of Risk of Injury/Release and Waiver. I acknowledge and understand that there may be a risk of injury involved in the activities that my child will engage in during the program. *

Agree

In consideration of my child's participation in the program, I hereby agree to release, waive, hold harmless, and shall indemnify One Life CPR, LLC, and their respective employees from liability to us and our child for any and all claims. *

Agree

I, the undersigned, have read this release and understand all of its terms. I execute it voluntarily and with full knowledge of its meaning and significance. *

Agree

I, the undersigned, hereby certify that to the best of my knowledge, my child is able to safely participate in the program activities for which he or she has been registered. *

Agree

By submitting this Minor consent form I agree to the terms listed above and provide my signature as proof of acceptance. *

Agree

Signature*

Sign in the box or use the keyboard to type.

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Date*

Month

Day

Year

Please let us know if there is anything about your child that we should know to help your child succeed in the class.

one
life
cpr training

© 2025 by One Life CPR. Powered and secured by Wix

Hours of operation

Mon-Fri: 8AM to 8PM

Sat: 10AM to 7PM

Sun: Closed

contact us

714 E. Kentucky Ave

DeLand, FL. 32724

Mail: onelifecprtraining@gmail.com

Tel: 813-842-0655

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Minor Consent Form

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