Family Medical Release Form- Page 1 (2022-2023)  

I hereby, give my permission (if applicant is a minor) for the applicant to participate in the UCC activities, virtual meetings, phone calls, and trips, including transportation from and to UCC.

If emergency medical procedures or treatments are necessary during the event, I authorize Upland Community Church staff or representatives to arrange for and consent to the procedures or treatment. I recognize that any medical treatment that is provided while attending an Upland Community Church activity/trip will be paid for by me or my insurance company.

Waiver and release of liability: In consideration of the minor’s participation, I hereby waive and release the employees and volunteers of Upland Community Church from any and all claims that I or my minor may have for losses, damages or injuries arising out of or resulting from my minor’s participation in the program, whether or not caused by negligence of the employees or volunteers of Upland Community Church. I HAVE READ AND VOLUNTARILY SIGNED THIS WAIVER AND RELEASE OF LIABILITY AND PERMISSION FORM.

I verify that the applicant is in good health and is capable of participating in strenuous activities, and when necessary, will tailor activities to those within the bounds of applicant’s physical health.

I certify that photographs and video of my child participating in church activities may be used in promotional materials for UCC, including our website (no names or contact information will be used) and private youth group Facebook pages (Junior High and Senior High Students only).


Page 1-   Parent/Family Information 
Page 2 - Children Information