Medical Release Form | Utah STEM & Arts

Utah STEM and Arts Academy, LLC. Emergency Medical Authorization, Health Disclosure, Assumption of Risk Agreement Form

IMPORTANT LEGAL NOTICE

This is a legally binding agreement between Utah STEM & Arts Academy, LLC (“Academy”) and the undersigned parent or legal guardian (“Parent”) concerning the minor student identified below (“Student”). By completing and signing this form, the Parent authorizes emergency medical action as described below, provides required health and safety information, acknowledges the inherent risks associated with Academy participation, and agrees to the terms contained in this form.

This form does not attempt to waive or release any claim belonging to a minor that cannot legally be waived under Utah law.

Parent Last Name

Parent Last name

Parent Email

Parent Phone

Parent Address

I represent that I am the Student(s parent or legal guardian and have legal authority to provide medical consent, authorize emergency treatment, provide the health information contained in this form, and enter into this Agreement. I will promptly notify the Academy if that authority changes or becomes restricted.