Transformers Club | Christmas Program

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Parent Cell #

* Parent/Guardian Email

* Names, ages, and grade levels for each child attending

Medical Release Statement

- I hereby release University Presbyterian Church, the staff, and volunteers from responsibility and liability for any injury or illness that my child may sustain during any event or program affiliated with University Presbyterian Church. In the event of an emergency, I hereby authorize any leader of this activity to act as an agent for me; to consent to any x-ray examination; medical, dental or surgical diagnosis; treatment; and hospital care advised and supervised by a physician, surgeon, or dentist (as appropriate)licensed to practice under the laws of Florida, either at the doctor's office or in any hospital. I expect that every effort will be made to contact me as soon as possible, and that these powers will only be used if attempts to contact me are unsuccessful.

* I have read and agree to the medical release as it pertains to Transformers Club and am providing this digital signature as acknowledgement

Photo Release Statement

- I grant permission to University Presbyterian Church to take photographs and/or videos of my child(ren). I grant permission for the photos to be used in publications, online, and in other communications related to the mission of University Presbyterian Church and its ministries. You must select 'yes' or 'no' in the field below.

* Photo Release

List any food allergies or medical concerns:

Medical Release Statement

Photo Release Statement

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