I have read and understand Heart Chan/ERRC's polices, rules, and regulations. I agree to adhere to these polices, rules, and regulations should I be accepted for my visit. I understand that failure to do so may result in the termination of my visit.
I acknowledge that all the information included in this application is true and complete. If any information provided in this application are misleading or false, I understand that Heart Chan/ERRC management has the right to remove me from the site immediately. I authorize Heart Chan/ERRC management to contact any of the individuals listed above to support this application and give permission for Heart Chan/ERRC management to do a criminal background check, using all information included in this application, with agencies from this state or any state or federal agency, to the extent permitted by the state and federal law.