OAPC Participant Form - Adult

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Stephen Ministry

The information requested below is designed to assist the church in updating our church database and caring for members in an emergency during church activities. Please complete the form below and submit. If you have any questions regarding this form, please contact the church office at 803-327-2006 or email oapc@oapc.net. Thank you!

OAPC Participant Form - Adult

Participant's Full Name

Name Preferred

Date of Birth

Street Address

City

State

Zip Code

Email

Cell Phone

T-Shirt Size

Work Status

Sunday School Class, Small Group, Activity Group

Emergency Contact: Name

Emergency Contact: Relation

Emergency Contact: Phone - Home

Emergency Contact: Phone - Cell

Emergency Contact: Phone - Work

Emergency Contact: Email

How do you prefer to receive information from OAPC? (Check all that apply.)

church publications

email

text

website

newsletter

Do you want to receive direct messages/updates regarding church news on your cell phone, via text and/or social media to stay informed?

Yes

No

Photo Release (Please check appropriate option.)

I grant Oakland Avenue Presbyterian Church mmy permission to use my photographs for any legal use, including, but not limited to, publicity, copyright purpose, illustration, advertising, and web content.

I grant Oakland Avenue Presbyterian Church my permission to use my photographs for limited use.

I do not grant Oakland Avenue Presbyterian Church my permission to use my photographs for any reason.

Medical Questionnaire: Are you presently being treated for an injury, illness, or taking any form of medication for any reason?

Yes

No

If Yes, please explain.

Medical Questionnaire: Do you have any allergies?

Yes

No

If Yes, please explain.

Medical Questionnaire: Do you require a special diet?

Yes

No

If Yes, please explain.

Medical Questionnaire: Do you have physical limitations or illness which would prevent you from participating in normal daily activity?

Yes

No

If Yes, please explain.

Notes, Comments, Other Information

Medical Treatment Authorization: I understand that an emergency contact will be notified in the case of a medical emergency. However, in the event that I am unable to make decisions and emergency contact cannot be reached, I authorize the calling of a doctor and providing necessary medical services in the event I am injured or become ill.

I agree.

I disagree.

Medical Treatment Authorization: I understand that Oakland Avenue Presbyterian Church will not be responsible for medical expenses incurred, but that such expenses will be my responsibility.

I agree.

I disagree.

Medical Treatment Authorization: I agree to notify Oakland Avenue Presbyterian Church in the event of any health changes which would restrict my participation in any activities of the church.

I agree.

I disagree.

Medical Treatment Authorization: I hearby give permissions to the physician selected by an adult in chrge to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery.

I agree.

I disagree.

Family Physician

Family Physician - Phone

Medical Insurance Provider

Medical Insurance Provider - Phone

Name of Insured

Policy Number

This form is valid July 1, 2023 through July 31, 2024. By typing your name below, you agree that this form of electronic signature has the same legal force and effect as a manual signature.

Date

Thank you for submitting your Adult Participation form. If you have any questions, or need to make any changes, please contact the church office. Have a great day!

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Oakland Avenue Presbyterian Church

421 Oakland Avenue, Rock Hill, SC 29730

Phone : 803.327.2006 Email : oapc@oapc.net

Office Hours : Monday - Friday, 8:00 a.m - 4:00 p.m.

For after hours emergency contact, please call 803.329.6276

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