Mohave Community College * 1977 Acoma Blvd, West * Lake Havasu City, AZ 86403 * PTA Program Support 928-505-3351
Mohave Community CollegeP
Physical Therapist Assistant Program
*Please note: You need to download and save the document to your computer first. Then re-open the document
to activate the digital signature box so you can digitally sign and email the completed form. You must have
Adobe Reader in order to digital sign the form. Do not click the lock document after signing the form.
Informed Consent for Lab Activities
During the course of the physical therapist assistant program, the student is required to take part in laboratory
activities which dictate that one student will be practicing techniques being taught and learned on fellow
classmates and/or faculty. It is the nature of the profession that skills be acquired on healthy individuals before
an attempt is made to become skillful with patient/client populations who have dysfunction. Therefore, students
and faculty must often “act” the part of the patient or client in order for the designated lab partner to gain skills
needed to practice physical therapy.
Although every effort is made on the part of the instructors to ensure safety for every student practicing and
playing the role of the patient or subject, it is possible that the student may experience some discomfort, either
physically or emotionally. By signing below, you are indicating your willingness to engage in those activities
which the faculty believes are necessary for you to learn skills related to the practice of physical therapy (such as
use of physical agents, therapeutic exercise, exposure of body parts, act as a patient simulator, etc.). While this
is an assumption that can be inferred from your acceptance to participate in the physical therapist assistant
curriculum and enrolling in the program, this is your active consent to do so. If there is any activity which may
cause you concern, you are urged to speak to the program director.
I understand that I will be asked to act as a lab partner during my experiences in the physical therapist assistant
curriculum and fellow classmates will be practicing skills taught by the professors of the course. I understand
that, at times, I may experience some physical or emotional discomfort, but i understand that this participation is
required for student learning and I willingly agree to participate fully.
I, _______________________________________________________, hereby assume all risks in connection
with and fully release Mohave Community College, its agencies and/or employees from any injury or damage to
me, and hereby acknowledge my understanding of this.
Dates Valid Through
Print Student Name
___________________________________________ Date: ___________________________________
click to sign
click to edit