Camp Moja Waivers and Releases
By filling out the information below you verify that you are authorized to sign for the camper as their legal guardian or as the camper themselves (and do not have a legal guardian).  If your answer to any of the below areas is "no" please close this window and email campmoja@gmail.com with any concerns.  Please be sure to include your camper's name and a good contact number.   

In order to participate in camp, responses must be "yes".  If you have any questions or concerns, please contact us.

If your camper has a Public Administrator as a guardian, please email campmoja@gmail.com for a paper copy to be filled out and returned prior to May 1.  PA guardians should NOT fill out this page.

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Campers First and Last Name *
Your First and Last Name *
Are you the... *
Your Email Address *
Your Phone Number *
Photo Release:  For and in consideration of the undersigned’s participation in a recreational activity sponsored by the Community of Christ, I hereby give my consent and authorize the Community of Christ, its successors, heirs, legal representatives, assigns and agents to use and reproduce my name, voice and/or likeness (photographic, illustrative, audio or video tape, film, electronic and/or digital image), and circulate and use the same for any and all official resource, use or purpose including but not limited to print, film, or electronic media and reproduction or digital representation of every description on the internet/world wide web.  Consideration is hereby waived in perpetuity, and no further claim of any nature whatsoever shall be made by me, my heirs or assigns.  The Community of Christ has made no representations concerning the use hereof to me.    I consent to the above statement on behalf of the camper. *
Treatment Consent and Immunization Certification Waiver :  I hereby give permission to the medical personnel selected by the camp director to order x-rays, routine tests, and treatment; to release any records necessary for insurance purposes; and to provide necessary related transportation for the camper listed on the reverse side of this form. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director or his agent to secure and administer treatment, including hospitalization, for the camper listed above. I also guarantee payment of all charges incurred by the camper. I hereby certify that all immunizations are current and up-to-date at the time camp starts. If, for religious or other reasons, the camper has not had any or all immunizations, I hereby willingly except all risks and waive any and all rights to any recourse if the camper is exposed (intentional or unintentional) to any and all illnesses or contagious conditions. *
Activity Participation Consent Waiver:  I hereby give permission for the above camper to attend Camp Moja & I will provide transportation for them to and from camp, while adhering to the designated times for each. If for any reason my camper needs to leave camp, due to illness or behavioral issues, I will provide transportation for them within the timeline provided by the camp directors. I will ensure that upon arrival to camp there is not any illness that would be harmful to him/her or any other individual and understand that the camper will not be allowed to remain at camp if they have a temperature above 100.5 F or a positive COVID test at check-in. This is an outdoor camp and it's important that campers are able to transport themselves (walking, walker, etc) up to a quarter of a mile on uneven terrain without assistance. If you have concerns about a new camper or if a returning camper has had any mobility changes from last year, please contact a director at campmoja@gmail.com prior to filling out the remainder of this application. *
Liability Release: The camper and/or parent/legal guardian/next of kin acknowledge that even though every effort is made to provide a safe, accident-free environment, incidents may occur. In consideration for being allowed by the Central Mission Center of the Community of Christ, for participation in this event, I, being 21 years of age or older, do for myself (and on behalf of the camper, if said camper is not 21 years of age or older)hereby release, forever discharge and agree to hold harmless the aforementioned camp, Central Mission Center and the Community of Christ and the directors, staff and volunteers thereof from any and all liability, claims or demands for personal injury, sickness or death as well as damage and expenses of any nature whatsoever which may be incurred by the camper that may occur while said camper is participating in this event. Furthermore, I (and on behalf of the camper if under the age of 21 years) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreating and work activities involved therein.Further, authorization and permission is hereby given to said organization to furnish any necessary transportation, food and lodging for this camper. I further agree to hold harmless and indemnify said organization, its directors, employees and agents for any liability sustained by organization as the result of negligent, willful, or intentional acts of said camper, including expenses incurred attendant hereto. *
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