EmailMe Form - 2025 Winston-Salem Stake YM Camp

EmailMeForm

YOUTH PARTICIPANT NAME *
First Last
T-SHRIT SIZE *
X-Small
Small
Medium
Large
X-Large
XX-Large
WARD/BRANCH *
Activity Preference - Rate the activities below according to your priority. 1 is most important and 4 is least important. Don't use the same rating more than once. *

My Priority

Paintball

Mtn Biking

Caving

Rock Climbing
Biking Ability *
Swimming Ability *
Birthdate *
MM / DD / YYYY
PARENT OR GUARDIAN NAME *
First Last
PARENT/GUARDIAN PHONE NUMBER *
### - ### - ####
PARENT/GUARDIAN EMAIL *
An address we can reach you with questions about your form, if needed. You will also receive registration confirmation.
MEDICAL INFORMATION. Does the participant have any of the following? If yes, please provide a repsonse in "Additional Medical Information" section below.
Special Diet
Allergies
Medication
Chronic/Recurring illness
Surgery or a serious illness in the last year
Physical conditions that limit activity
ADDITIONAL MEDICAL INFORMATION:
OTHER ACCOMIDATIONS OR SPECIAL NEEDS

Identify any needs or considerations the participant has that the Stake leaders planning this event should be aware of:
PARENT/GUARDIAN PERMISSION:

If this registration is for a youth participant under the age of 18, it MUST be signed by a parent or legal guardian, with the following understanding. I hereby consent that I am the parent or legal guardian of the named individual below and hereby give my consent without reservation to the forgoing on behalf of this participant.

I give permission for my child/youth to participate in the activity listed above and authorize the adult leaders supervising this activity to administer emergency treatment to the above-named participant for any accident or illness and to act in my stead in approving necessary medical care. This authorization shall cover this activity and travel to and from this activity.

TERMS OF PARTICIPATION:

The participant is responsible for his or her own conduct and is aware of and agrees to abide by Church standards, camp, or event safety rules and other pertinent instructions. Participant’s
conduct and interactions should abide by Church standards and exemplify Christlike behavior.

Parents and participants should understand that participation in an activity is not a right but a privilege that can be revoked if they behave inappropriately or if they pose a risk to themselves or others.

PHOTO RELEASE:

I hereby grant permission and authorize the Winston-Salem Stake the right to take, edit, alter, copy, exhibit, publish distribute, and make use of use of any and all pictures and videos of the participant to be used in and/or for church promotional materials including but not limited to newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits, and submissions to journalist, websites social networking sites, and other print and digital communications without payment or any other considerations.

This authorization extends to all languages, media, formats and markets now known or hereafter devised and shall continue indefinably unless I otherwise revoke said authorization in writing.

I understand and agree that these materials shall become the property of the Winston-Salem Stake and will not be returned. I hereby hold harmless and release the Winston-Salem Stake and its leaders from all liability, petitions, and causes of action which I, my heirs, representatives, executors, or any other persons may make while acting on my behalf or on behalf of my estate. *
Check Here
Parent/Guardian Signature

(Or signature of participant--if over the age of 18) *
Clear

	My Priority
Paintball
Mtn Biking
Caving
Rock Climbing