Student Permission Form - Virginia
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Virginia Office of Emergency Medical Services
www.vdh.virginia.gov/oems
EMS.TR.07
Revised: July 2011
Student Permission Form for BLS Students
Less than 18 Years Old
Virginia Office of EMS
Division of Educational Development
1041 Technology Park Drive
Glen Allen, VA 23059
804-888-9120
Dear Parent/Legal Guardian:
Your daughter/son has expressed an interest in being certified as an Emergency Medical Services Provider. The Office of
Emergency Medical Services, Virginia Department of Health requests that you take a moment to review this letter. If you have
any concerns, please discuss them with your daughter/son, the EMT instructor, or someone at the Office of Emergency
Medical Services. (1-800-523-6019)
The Emergency Medical Services (EMS) Basic Life Support (BLS) Course is a program which trains people to assist injured or ill
individuals outside the confines of a hospital. The curriculum used in Virginia is a nationally recognized program developed by
the U.S. Department of Transportation.
The curriculum requires a minimum of number of hours of classroom instruction and for Emergency Medical Technician
programs an additional 10 hours of clinical experience either by hospital emergency department observation, or a ride-a-long
on an ambulance. Following successful completion of a State approved course, the student is allowed to take the State
Certification Examination. Passing both the written and practical aspects of the State examination certifies the student to
perform the duties of an EMS provider.
Because of the responsibilities placed on an EMS provider, the State of Virginia requires that anyone less than eighteen (18)
years of age must have permission from their parent or legal guardian to become certified as an EMS provider in Virginia. The
individual must be at least sixteen (16) years of age before the course starts to enroll in an EMS program.
To participate in the delivery of health care can be a very rewarding experience. However, the responsibilities of an EMS
provider are great and at times extremely stressful. The balance of a patient's life may rest with the actions taken by the
provider. The consequences of such situations can be positive; but can also be a source of frustration, guilt, and emotional
distress. Physical injury is also a very real possibility.
EMS providers are at a greater risk of exposure to infectious diseases, hazardous environments, and violent behaviors.
Emergency Medical Services' training programs provide information on how to protect oneself when dealing with these
hazards. However, the nature of EMS activities tends to place EMS providers in dangerous situations where the maturity and
experience to deal with critical decisions is of the most importance.
APPLICANT/STUDENT INFORMATION:
Name
Last Name First Name MI
Mailing Address
+
Number, Street, Apt. City State Zip +4
E-mail Address
(over)
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