I, the undersigned First NameLast Name , am the parent or legal guardian of the child/youth named First NameLast Name , who was born on Date of Birth and lives at Street AddressAddress Line 2CityStateZip . I will be available for the phone call at Area CodePhone Number . As a parent or legal guardian, I affirm that I have been completely informed all the activities that the child/youth will participate. I understand the general structure of the programs and do not need to be informed of each and every activity. By signing this form I give permission for my child to use UCAN transportation for field trips and after the program is complete to go home. I hereby voluntarily release, forever discharge the community, the corporation, its officers, directors, employees, volunteer and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in the programs or the use of the equipment and facilities. I agree to pay for any and all medical expenses incurred and give permission to the doctor or health care professional to provide medical care if necessary. The information I've given in this form is complete and accurate. By signing this form on Date , I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect. Signature