• UCC Medical Release Form

  • Student Information:

  • Parent/Guardian Information

  • Person other than parent to contact in case of emergency:

  • Insurance/Medical Information

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  • As Parent and/or Guardian of the named student, my son/daughter has my permission to be treated and/or cared for by a designated representative of University Christian Church. Said person may delegate emergency treatment as deemed medically necessary. I understand that all reasonable safety precautions will be taken at all times by University Christian Church and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold University Christian Church, its leaders, employees, and volunteer staff, et al., liable for damages, losses, diseases, or injuries incurred by the subject of this form.

    By signing this form, I authorize University Christian Church to use pictures and/or video footage of my child for its social media, website, or other promotional materials.

  • Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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