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Pursue 2026- Permission Form
This form is for the parent/guardian of OCC's Pursue 2026/2027 attendees to provide student information and health insurance information
Your name
*
Last name
Email address
*
Student First Name
*
Student Last Name
*
Address: Street
*
Address: Apt/unit/box (optional)
Address: City
*
Address: State
*
Address: Postal Code
*
Student's Birthday (MM/DD/YYYY)
*
Student Email Address
*
Student Cell Phone Number (XXX-XXX-XXXX)
*
Student's High School Graduation Year
*
What is the name of the church you attend?
*
I do not wish for my student to be on the OCC mailing list.
Insurance and Health Information
Health Insurance Company Name
*
Health Insurance Policy Number
*
Parent/Guardian Consent
By checking this box, I am digitally signing the Electronic Medical Release Form (EMRF)that can be found at occ.edu/emrf.
*
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Parent/Guardian Emergency Number (XXX-XXX-XXXX)
*
Submit
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