UYG Medical Form

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UYG Medical Form

If there is an incident that arises that would require medical attention for my child
named below, I hereby give full authority to University Church of Christ and/or its
designee(s) to have such medical treatment performed on my child.

Child's Name *

Child's Age *

Child's Date of Birth *

YYYY

Home Address *

Known allergies

Emergency Contact (Name & Phone) *

Medical Insurance Company *

Policy # *

Release of Liability *

I agree

I hereby release the University Church of Christ, its elders, and/or their designee(s) from any liability that may occur causing medical attention for my child during any church-related activities involving my child.

I give permission to the University Church of Christ to use any pictures/videos that may be taken at a church-related activity that my child may be in. I understand that these pictures may be used in University Church of Christ publications, web pages, and/or social media pages.

I agree

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