What is a Waiver Form?

What is a Waiver Form?

When participating in clinical placements, you may be placed in environments that contain risks and dangers such as and not limited to, illness, infection, bodily injury or exposure to communicable diseases such as and not limited to: 

  1. Measles,
  2. Mumps,
  3. Rubella,
  4. Varicella,
  5. Polio,
  6. Tuberculosis and
  7. Hepatitis B. 
In some situations a person's immunity status cannot be determined by means of laboratory evidence or immunology history.  In these situations, you must decide to either continue or refuse to participate in the clinical placement given your indeterminate immunity status.

If you choose to continue, you must complete a Waiver document.  This document is intended to help you make an informed decision regarding the risks associated with continuing in a clinical placement given your indeterminate immune status.  It will acknowledge that you understand the risks associated with attending a clinical placement and that you have been made aware of these risks.  If you choose to refuse participation, you must contact your program coordinator directly.


If you are required to complete a waiver document, Synergy Gateway will provide the school created form to you.