Authorization for Medical Care and Image Use Form

Students over the age of 18 must complete, sign, and submit the Authorization for Medical Care and Image Use Form prior to the start of the program. Download and print a PDF copy of the release form here.

For students under the age of 18, a parent or guardian must complete, sign and submit the Authorization for Medical Care and Image Use Form prior to the start of the program. Download and print a PDF copy of the release form here.

Signed forms can be mailed to:

  • Westmont College
  • ATTN: Westmont Summer Scholars
  • 955 La Paz Road
  • Santa Barbara, CA 93108-1099
  • Only originals can be accepted. Completed forms cannot be faxed or scanned.