Youth Medical Release - Only to be filled out by Legal Guardian

Form only to be filled out and submitted by a Legal Guardian who will be responsible for and responsive to communications regarding the child and their registration with any Seacoast Grace activity or event. The below information (Name, Phone Number, Email) must be of the Guardian, not the student

Download Form: https://drive.google.com/uc?export=download&id=1iW1gDEzJALdTsh0dEH5oASzoiENp5P-L

Your name *

Email address *

Phone number *

Phone number of you the Legal Guardian, not the student

Your Contact Information (Legal Guardian)

Name - First and Last *

Email (active, available to be contacted through in case of emergency) *

Relationship to Student *

Youth Medical Release Form *

Your child is due for a Youth Medical Release Form! Please fill out both pages of the form linked above and submit it here to be saved to your child's account profile.

*Forms will only be valid for one event at a time and continue to need to be re-submitted unless signed to be valid for longer.

Please submit a separate form for each individual student you have registered for this event.

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Recognition of Submission *

As the legal guardian of this child, I recognize that by submitting this Medical Release Form with my contact information, I am responsible to be an accessible point of contact for any communication regarding my student's wellbeing while attending any Seacoast Grace activity, service, or event.

Student Information

Please provide the below information for the student, including one of the optional forms of contact (email or phone number).

Gender *

Birthdate *

School

Grade

Student Email

Phone number