MFOMS Registration

Mfoms REGISTRATION

Many Faces of Moebius Syndrome CAMP MOEBIUS
at
Waycross Camp and Conference Center

Date: August 4th-7th, 2022
Location: Waycross Camp & Conference Center 7363 Bear Creek Rd Morgantown, Indiana 46160

For additional information and photos of Waycross, please visit Waycross Camp and Conference Center at www.waycrossccc.org . If you have any additional questions for Many Faces of Moebius Syndrome, please contact Andrea Smith at Andrea@mfoms.org.

Travel to and from Camp Moebius is NOT included in fees below. Travel is the responsibility of the camper.

Name of Individual/Family: *

First

Last

Total members attending *

Email *

Accommodation Type *

CONFERENCE CENTER
SLEEPING WING
COMMUNITY CABINS

If rooming with another Adult that is not family, please state Name of roommate and choose double occupancy:

IS ANYONE N-TUBE or G-TUBE FED (and will NOT be dining on the provided included meals)?

Age

Name of adult/adults:

T-shirt size (S-4XL)

T-shirt size (youth S-XL, Adult S-XL)

Name of child/children:

Age

ADA room required for wheelchair (Conference Center only)? Y or N

FIRST FLOOR room required? (Conference Center only) Y or N

FOOD ALLERGIES: Y or N

ENVIRONMENTAL ALLERGIES: Y or N

If yes, list allergies:

Vegan diet: Y or N

Gluten Free: Y or N

SPECIAL DIET other than above required?

Any physical limitations (this will help us plan group events)?

Is there anything special you enjoy doing that can help us plan activities?

Adults: If attending as a single occupancy camper, would you like to be paired with a same sex adult camper for room sharing, if possible? Y or N

If you have made rooming arrangements with another adult, please state their name:

I also understand and give permission to the Indemnified Parties to use my name or images of my participation in MFOMS Camp Moebius for publicity or promotional purposes, without liability or obligation to compensate me.

Agree

I agree Terms & Conditions

Liability Name

Liability Initial

Mfoms REGISTRATION

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