Elfies

Ages 4-6 will enjoy time together learning to sing along to simple holiday songs, simple choreography, will enjoy craft time, tot lot time and will join the older group for dinner. Our “Elfies” will have a mini-performance before the Elf, Jr. show on Friday Dec. 19. Classes meet on Tuesdays from 4:15-6:00pm. Classes begin Sept. 9.

If you have any questions or concerns, please contact Erin Thomas at (804) 232-1769 or westoverhillsumc@gmail.com

Child Name*

First NameLast Name

Age as of June 1st, 2025*

Grade in Fall of 2025:

Date of Birth*

MonthDayYear

Sibling Name

First NameLast Name

Sibling age as of June 1st, 2025

Sibling Grade in Fall of 2025:

Sibling Date of Birth

MonthDayYear

Parent / Guardian *

First NameLast Name

Address*

Street Address

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CityState / Province

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Best phone number to reach you during the day. *

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Pediatrician Name*

Pediatrician Phone Number*

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Does your child/children have any ALLERGIES? *

Please list two people to be called in an emergency if parent cannot be reached:

Name*

First NameLast Name

Phone Number*

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Name*

First NameLast Name

Phone Number*

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The person(s) listed below are allowed to pick up my child:

The person(s) listed below is NOT authorized to pick up my child(ren):

In the event that I cannot be reached immediately, I give WHUMC permission to transport my child to a hospital if necessary and obtain medical treatment for my child named above.

Cost-$250*

Elfies by WHUMC and Arts To All

$250.00 Quantity

Product Name

$ Free Quantity

Total

$0.00

Payment Methods

Credit Card

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Email*

example@example.com

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Westover Hills United Methodist Church during the selected camp. In exchange for the acceptance of said child’s candidacy by Westover Hills United Methodist Church, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Westover Hills United Methodist Church. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Westover Hills United Methodist Church. including all instructors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Medical Release and Authorization As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Westover Hills United Methodist Church. and its affiliates including Staff and Instructors to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered camp. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Photo Release and Authorization

I hereby consent to the publication and use of my child’s name and/or my child’s likeness (“Likeness”) for the purpose of promotion, publicity, advertising, or other manner or media by Westover Hills United Methodist Church, or any other representative authorized to act on behalf of the afore-mentioned entity. Likeness shall include, but not be limited to, photographs, sound and/or video recordings, brochures, publications, reports, web pages, promotional materials or any other audio-visual, electronic, printed, tangible work in any media or format, now known or hereafter to become known, and/or reproductions of any of these. I agree that the actual material involved is and shall continue to be the property of Westover Hills United Methodist Church and that neither I, nor my child, shall have any right of review or approval regarding the use of my child’s name and/or Likeness in such material. I hereby release and hold harmless, Westover Hills United Methodist Church along with their respective employees, agents, affiliates, sponsors, or other representatives from any and all claims, demands, or causes of action arising out of the use of my child’s name and/or Likeness, in accordance with the terms of this release. I understand and agree that neither I, nor my child, will be compensated in any way for the use of my child’s name and/or Likeness by Westover Hills United Methodist Church.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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