Medical Information and Release for Adults – St Paul Church of Columbus

Please complete the information below. At any time, you may save your answers and continue at a later time. When you are finished, you will be asked to electronically sign your liability release form. This is to be completed by those who will participate on a St. Paul event who are 18 years old or older.

All Information is securely encrypted and sent.

Step 1 of 4

Adult Participant Information:
What Event/Trip Are You Participating?*
When is this Event/Trip?*
Name*
First Middle Last Suffix
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Enter Email Confirm Email
Date of Birth*
Month
Day
Year
Home Phone*
Cell Phone*
Physician's Name*
Physician's Phone Number*

Save and Continue Later