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Northeastern University Consent to Participate & Release of Liability SEND COMPLETED FORM TO BTC@NORTHEASTERN.EDUPARTICIPANTS NAME:___ AGE:___ ADDRESS:___ CITY:Online Question CenterSTATE:___ZIP:___09/26/2023
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Consent to participate release is a form signed by an individual, giving permission to take part in a specific activity or program.
Anyone who wishes to participate in the activity or program that requires it.
Fill out the required fields with accurate information and sign the form where indicated.
The purpose is to ensure that participants understand the risks involved and agree to participate voluntarily.
Participant's personal information, description of the activity, risks involved, and signature.
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2020 2023 btcnortheastern edu releasors universitys designees promulgated successors undersigned referenced audiotape assigns applicable northeastern arising perpetuity administrators attest certify acknowledgment incurred healthcare intending participant

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