2022-2023 ATHLETE RELEASE FORMS
Congratulations!  Your student a UCS Lions' Athlete!

To participate in ANY UCS Sport, the following forms must be complete before starting ANY practice.
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Email *
MEDICAL INFORMATION FORM
Athlete First Name *
Athlete Last Name *
Street Address *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Grade *
Please list all allergies and indicate if the athlete has an epipen. *
Current Medications *
Parent First Name *
Parent Last Name *
Parent Street Address (if different than athlete):
Parent Phone Number *
Please list two additional emergency contact (include phone number) *
Name of Primary Insurance Policy Owner: *
Insurance Company: *
Policy Number: *
Secondary Insurance Policy Owner:
Secondary Insurance Company:
Secondary Insurance Policy Number:
I hereby give permission for authorized personnel of Unity Christian School to grant permission for medical treatment for my child, if I am not readily available, and I authorize the physician and such other health care provider selected by Unity Christian School to render such emergency medical treatment as deemed necessary under the circumstances. (Please type authorizing name below). *
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