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Applicant's Information
Educational Background
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Person to Contact in Case of Emergency
Terms and Conditions

"Ally College reserves the right to reschedule or cancel any course that does not meet our minimum enrollment requirements. If a course is cancelled or rescheduled, all fees paid are subject to reimbursement or transference, upon presentation of a receipt. I am aware attendance in 100% mandatory and any absences during the first 16 hours of class will require me to retake the entire class and cost of the program again. I also understand If I must make up any hours outside of class, I will be assessed at least $10.00 per hour to make-up any loss work."

"Ally College does not discriminate based upon sex, race, color, national origin, religion, age, disability, sexual orientation, gender identity/expression, ancestry, familial status or military status with regard to admission, access, treatment or employment."

Hepatitis B Immunization Information

A highly contagious virus that infects the liver causes Hepatitis B. The virus is found in the blood and body fluids of infected people. Safe, effective Hepatitis B vaccines are recommended for health care professionals because of their exposure to blood and body fluids.

The vaccination series, generally given as 3 doses over a 6-month period, protects those at risk and contributes to the elimination of Hepatitis B. The Hepatitis B vaccine is recognized as the first anti-cancer vaccine because it can prevent liver cancer caused by Hepatitis B infection. Hepatitis B vaccine is safe and effective. The potential risks associated with the Hepatitis disease far outweigh the potential risk associated with the Hepatitis B vaccine.

I understand that I have the opportunity to ask questions and that I understand the benefits and risks of the Hepatitis B immunization. I understand that I must have three (3) doses of the vaccine to develop immunity. However, as with any medical treatment, there is no guarantee that I will become immune or that I will not experience an adverse side effect from the vaccine. I understand that, due to my occupational exposure as a health professional to blood or other potentially infectious materials, I may be at risk of acquiring Hepatitis B. I may choose to be vaccinated with the Hepatitis B vaccine at my own personal expense. I will contact a private physician or health clinic in order to receive the vaccine.

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Date Signed: 04/04/2020