We collect this information for grant reporting purposes. Selection is optional if you wish not to identify.
We encourage you to provide a copy of the student's IEP upon enrollment. This information helps us provide the best learning environment possible.
If not, contact Program Director as soon as possible
We collect this information for grant reporting purposes.
Emergency Contacts and Authorized Persons
List name, phone number, and relationship to child
The fee for the United Learning program is $25/week. Please select a payment preference below.
In the event that my child becomes ill or sustains any injury while attending the youth program at UCHM and/or while on an authorized and chaperoned activity sponsored by UCHM (on or off UCHM property), I, the undersigned, give my permission to the adult leader(s) to administer first aid and/or CPR and to select a physician and/or hospital for my child’s care, releasing her/him from liability for their actions. UCHM Youth Program Staff are CPR/First Aid Certified.
Also, I give the emergency care personnel, physicians, and/or hospital my permission to examine, treat, and provide medical, dental, or surgical diagnoses for my child. They may also x-ray, administer medication or anesthesia as deemed necessary.
Further I give EMS and any other emergency transportation service my permission to transport my child. I understand that this consent and release will apply to all emergency situations present and future.