Form

Update Information

Please complete the form below for any youth 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.

Youth's Name(Required)

First Last

Child's Date of Birth(Required)

Child's Grade in School

Parent's Name(Required)

First Last

Parent's Cell Number(Required)

Emergency Contact Name (other than parent)

First Last

Emergency Contact Phone

Youth Cell Number

Youth Email

May we publish youth cell and/or email in Church Directory?

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 the supervising adults to seek appropriate emergency medical treatment for my child should it be necessary to do so. I assume responsibility for any medical bills incurred

Media Release

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

Travel Release

I give my permission for my child/children to travel with adult chaperones from First Presbyterian Church during church sponsored activities and trips.

Signature of parent or guardian

Form

Update Information

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