Laboratory Participation
Agreement
Physical Therapist Assistant Program
I, (name) , agree to participate in Indian Hills
Community College Physical Therapist Assistant program laboratory activities. I will be expected to attend
laboratory activities scheduled at on and o campus locations. During the laboratory experiences I will role-
play as a PTA and patient. I will be expected to have physical contact with other students while learning various
examination skills and therapeutic interventions. Examples of such laboratory experiences include palpation
of exposed anatomical landmarks and application of various therapeutic modalities. During the laboratory
experiences I agree to follow theories and principles of safe, legal and ethical practice.
It is your responsibility to inform the instructor if you have a medical condition or injury which would preclude you
from participating in lab or being used as a demonstration model. If the condition is ongoing, the instructor will
require a physician’s note.
Name:
Signature: Date:
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