Form

Update Information

Please complete the form below for any adult participating in activities or trips lead by First Presbyterian Church Greer.

This form should be completed annually or anytime a change is made to the information requested.

Name(Required)

First Last

Date of Birth(Required)

Emergency Contact Name

First Last

Emergency Contact Phone

Health Insurance Name

Health Insurance Policy Holder Name

Health Insurance Policy Number

Health Insurance Phone Number

Please list any Allergies, Surgiers or other Medical Needs that the church should be aware of.

Please list current medications

Date of last Tetnus Shot (must be current)

Medical Release

I give my permission to representatives of First Presbyterian Church to seek appropriate emergency medical treatment for me should it be necessary to do so. I assume responsibility for any medical bills incurred

Media Release

Regarding video and photography taken of myself during church activities, I give FPCG permission to use these for display, church newsletters, publications, on the church website and social media posts.

Signature

Form

Update Information

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