First
Congregational Church
United Church of Christ
225 S Interlachen Ave.
Winter Park, FL 32789
Phone: 407-647-2416
mailto: fccwp@fccwp.org
Bryan G. Fulwider,
Sr. Minister
Karen E. Barker-Duncan,
Associate Minister
Talia R. Raymond,
Minister of Arts
and Education
Sherie A. Lindamood,
Worship Minister
John V. Sinclair
Music Director
Christina Carter,
Children's and Youth
Choirs Director
Chris Olivent,
Organist
Liz Kitchens,
Commissioned Minister
of the Arts
Karen Sinclair,
Preschool Director
Mary Joe Searl,
Administrator Donna Borko,
Secretary
W.I.N.G.S. YOUTH GROUP HEALTH FORM First Congregational Church of Winter Park
225 South Interlachen Avenue Winter Park, FL 32789
407-647-2416 http://www.fccwp.org
* Required
Errors
Part 1: GENERAL INFORMATION
Check all of the following that apply:
Medical History
PART 2: PERSON(S) TO NOTIFY IN CASE OF EMERGENCY
PART 3: IN CASE OF ACCIDENT OR ILLNESS
I hereby give permission to the medical personnel, selected by the FCCWP staff, to provide necessary transportation and secure proper treatment, to order medications, hospitalization, anesthesia, and surgery for:
