Medical Form

In order for students to participate in the USC, parents/guardians must complete a Medical Waiver form.

COMPLETE ONE MEDICAL WAIVER FORM PER CHILD.

MEDICAL DISCLAIMER

To participate in ministries of the Urban Scholastic Center (hereafter referred to as The USC), I (the parent/guardian) hold harmless and release USC, its directors, officers, employees, volunteers and agents from liability for any fault, mistake, negligence, or omission causing damage, loss, injury, or bodily injury to me or my child arising from participation with USC, including any damage arising from the provision of emergency medical treatment. The terms of this Waiver are governed by the laws of the state of Kansas.

In the event I cannot be reached in a case of emergency, I hereby authorize USC, its officers, directors, agents, employees, or their designated medical professionals to make emergency medical decisions (i.e. doctors, hospitals, medical treatment, etc.) and/or to administer emergency medical assistance. I accept responsibility for payment of expenses incurred as a result of any medical treatment.

Medical Waiver Form