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Name

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Last

Contact of Government

Communication Address

Mobile Number

Mobile Number-(WhatsApp)

Emergency Contact Name

Emergency Contact Number

Date of Course

Applicant Type

Healthcare Professional(Doctor/Nurse/EMT/Medical professional)
Non-Healthacare provider

Select Course

Location

Qualification

Designation

Government ID Proof Number

Upload Government Id card

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Upload Qualification Document

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Student Consent & Medical Fitness Declaration

Effective Date: 1-October-2025
Version: 1.0

1. Purpose

The purpose of this declaration is to ensure that every participant attending an American Heart Association (AHA) course at Zenplus Private Limited AHA International Training Center (ITC) is physically and medically fit to participate in all course activities, including the performance of high-quality CPR skills, as required by AHA training standards.

2. Student Declaration

I hereby confirm and declare the following:

I am physically and medically fit to participate in the AHA course I have enrolled in (BLS / ACLS / Other AHA course) at Zenplus AHA ITC.

I understand that the course involves active physical participation, including kneeling on the floor, performing high-quality chest compressions, ventilations, and using training equipment such as manikins and AED trainers.

I declare that I do not have any medical condition, injury, physical condition or limitation that would prevent me from safely performing CPR skills to the standards required by AHA.

I understand that if I am unable to meet the physical skill requirements during the course, Zenplus AHA ITC, Instructor, or the Faculty have the right to deny certification, in accordance with AHA guidelines.

I take full responsibility for my physical participation in the course and will immediately inform the Instructor or Training Center Coordinator if I experience any discomfort or medical issue during the training.

I hereby give consent to participate fully in all training activities and assessments as part of the course.

3. Disclaimer

This declaration does not replace medical advice. Participants with any health concerns are encouraged to consult a medical professional prior to attending the course.

Neither AHA, Zenplus Private Limited, nor any of their directors, instructors, faculty, training center coordinator (TCC), or employees shall be held liable for any claim, penalty, injury, or damages arising from course participation or due to false/incomplete information provided by the participant.

I have read and understood the above declaration and consent form. I voluntarily agree to participate in the training course and accept the physical requirements involved.

Registration Form

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Need emergency support?

1800 102 1298

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Zenplus Private Limited

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Need emergency support?

1800 102 1298

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