Wesley United Methodist Church - CA

Camp Mochi Registration Form 2024

Child Name

Age

Grade

Allergies/Special Concerns

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Cell Phone

Email

MD Name

MD Address/City

MD Phone

MEDICAL & LIABILITY RELEASE

As the parent/guardian of

I grant permission and empower the staff of Wesley UMC, its pastors, staff, counselors, advisors, and/or agents (hereinafter WUMC), to make any necessary decisions involving the above said child(ren) in case of emergency. In no event will the UMC or WUMC be held liable for any first-aid rendered, treatment, drugs, medicine, or surgical procedures performed pursuant to this consent. In said case, the parent/guardian will be responsible for any eexpenses incurred for any procedures performed. In the event of emergency, every effort will be made to contact the parent/guardian before any medical services may be rendered, aside from the adinistration of general first-aid. Copies of this form made by the staff of WUMC will be considered original.

Agree

PHOTO & VIDEO RELEASE

I hereby give WUMC the right and permission to copyright and publish, without charge, photographs and/or videos taken of said minor. Permission is granted to use such photographs and/or videos in promotional literature, publications (both print and electronic) , advertising, and in similar ways as associated with WUMC and its organizations. This includes but is not limited to church and youth group newsletters, organization brochures, and church website.

Agree

These Releases are effective for Camp Mochi on December 28, 2024.

Parent/Guardian Name (Typed)

Parent/Guardian Name (Signature)

Date

Payment method

send/sent a check to Wesley

pay/paid online

$30/per child
for a check: make checks payable to "Wesley UMC"
online payment: https://www.wesleysj.net/event/2wj8kk6/camp-mochi

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Camp Mochi Registration Form 2024

MEDICAL & LIABILITY RELEASE

PHOTO & VIDEO RELEASE

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