UCMC Form

This online form was created to make the waiver process more convenient so you dont have to duplicate information. You may also print blank forms and complete them by hand. Blank forms here!

Instructions:

1. Fill out the form and submit

2. On submission, completed waivers will be sent to you for you to print, sign and initial.

3. Bring the waivers to the gear cave before or after a meeting at least 1 week in advance of your trip.

Important

Completion of this online form does not constitute submition of the waivers. You must print and deliver them in person. There are no exceptions!

UCMC will not use your data for anything other than UCMC club activities.

You are agreeing to complete the forms in this manner by proceeding.

Contact Information:

General Information:

Date of Birth

Select Status-- Freshman Sophomore Junior Senior Graduate Alumni Other

I dont have an M Number

Local Address:

If you dont have a local address put your current address

Permanent Address:

Same as Local Address

Emergency Contact:

EC Prefered Phone Cell Home Work

Cell:

Add home and work phone if applicable

Home:

Work:

Emergency Contact Address:

Same as Permanent Address

Medical Details:

We cannot accept waivers that dont have insurance information, EVERYONE at UC has medical insurance so please dont tell us you dont know! We hear it a lot. If you have UC health insurance use your M number

Must write "none" if this does not apply. Information that medical personnel would need to know. Allergies, medications, ect.