JMC Application Form

JMC Application Form

Saturday 21st June - Sunday 22nd June 2025
Name of Camper*

First NameLast Name
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Conditions/ Allergies/ Medication*
Note any known conditions/allergies (e.g. Asthma, diabetes, epilepsy) and medication being taken/ emergency medication
Dietary Restrictions*

NoneVegetarianVeganGluten FreeDairy FreeOther
Special Requirements
Please provide details of any special requirements or additional information we should be aware of

Emergency Contact
Emergency Contact Name*

First NameLast Name
Relationship to Camper*
Address

Address same as camper
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*

Alternative Emergency Contact
Alternative Emergency Contact Name*

First NameLast Name
Relationship to Camper*
Address

Address same as camper
Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email

Doctor’s Contact Information
Doctor’s Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number

Photographs
Group photographs will be taken during camp. These may be used to publicise future events or added to our JMC Facebook page (private) to. Please confirm below if you consent to your child being included in these photographs.*

I consentI do not consent
Camper Acknowledgement
I am aware that alcohol/illegal drugs/weapons are not allowed. If any of these items are found in my possession this will result in my being sent home. I acknowledge the need for respectful and responsible behaviour at camp.*

I acknowledgeI do not acknowledge
Parent Acknowledgement
I agree to my child taking part in this residential and, having read the programme, agree to their participation in the activities described. In the event of illness or accident, having parental responsibility for the above named child, I give permission for first aid to be administered where considered necessary by a trained first aider, if available, or medical treatment to be administered by a suitably qualified medical practitioner.*

I agreeI do not agree
Data Protection
We are collecting this information so as to help ensure that activities for children and young people organised by Friends are in compliance with the Child Safeguarding Policy in place within the Religious Society of Friends.

The purpose of the policy is to protect children and young people from harm.

If you are unable to supply the information requested, we will be unable to register your child to attend the camp. Only those specifically involved in the organisation of the camp will have access to the information on this form.

We will NOT pass this information onto anyone else. This form will be kept on a password protected computer.

Payment
The cost of Junior Moyallon 2025 is:

£55 / €65 for first child in a family

£50 / €60 for any additional child in a family

We prefer all payments to be made via bank transfer to:

Junior Moyallon Camp

Ulster Bank

Account Number : 78066040

Sort code : 98 - 12 - 90

Cash payments, including Euro, can be made on arrival at camp.
Contact Details
Additional details for this years camp programme and helpful information can be found in the accompanying flyer for JMC.

If you need any further assistance, or have any questions, please get in touch:

Email: juniormoyallon@gmail.com

Phone: +44 (0) 7803 158 339

Facebook: Junior Moyallon Camp
Should be Empty:

JMC Application Form

Emergency Contact

Alternative Emergency Contact

Doctor’s Contact Information

Photographs

Camper Acknowledgement

Parent Acknowledgement

Data Protection

Payment

Contact Details