Northeast: Individual Registration

The camp you're trying to register for has already ended.

Please double check with your Church Coordinator that the digits at the end of your registration URL are correct.

You're registering to go with: NYAC

Your Church Coordinator Is: Gina Grubbs

Camp Location: Hicksville, NY 11801
Camp Date: 06-03-18 - 06-09-18
Camp Type: Long Island - Young Adult

If this information seems incorrect, please contact your Church's U.M. ARMY Coordinator to make sure you have the correct URL.


Welcome to the U.M. ARMY online Individual Registration Form.

The form to the right has 7 Sections:

  • Your Personal Information
  • Parent Information (if applicable)
  • Emergency Contact Information
  • Vehicle Information (if applicable)
  • Medical Information
  • Skills And Experience
  • Rules And Agreements


Please fill out each of the sections as completely as possible.


Much of the form is required information. Calculations will be done to help determine the required information for you.


After filling out the form, you will be given the opportunity to review the information. If you would like to make any changes to the form, please do so at this time.


In addition to the online form, you will need to download and sign the "Press and Medical Release Form" (Available Here), and turn it in to your Church Coordinator.


Your Church Coordinator will be contacted by email, confirming that you have signed up to go with the NYAC group.


You will also receive an email with login information for the system. On this site, you'll be able to keep up with all of your camp information, such as: Your Personal Information, Camp Role Assignments, etc...


Personal Information

First Name
Last Name
Preferred Name
Date of Birth

Format: mm/dd/yyyy

Grade Completed at End of Current School Year

If applicable

Shirt Size

Adult Sizes

Street Address
Home Phone
Cell Phone
Email Address
Please List Other Family Members Attending Camp

Parent Information

If registration is for youth

Parent First Name
Parent Last Name
Parent Cell Phone
Parent Email Address

Emergency Contact Information

Emergency Contact
Emergency Contact Phone
Emergency Contact Relationship

Vehicle Information

Required if bringing vehicle to be used at camp

Vehicle Type
Number of Seatbelts

Medical Information

Please List Any/All Medical Conditions
Please List Any/All Medications That Will Be Taken At Camp
Please List Any/All Mental Conditions
Please List Any Medical/Mental Accommodations That Are Needed
Please List Any Food Allergies Or Special Dietary Needs
Name of Medical Insurance Company
Name of Medical Insurance Policy Holder
Medical Insurance Policy Holder DOB
Medical Insurance Group Number
Medical Insurance Phone Number

Skills And Experience

Have You Attended U.M. ARMY Before?
If Yes, How Many Times Have You Attended?
What Was The Last Year You Attended U.M. ARMY?
Adults, Check The Leadership Roles In Which You Are Willing To Serve

Please Rate Yor Skills On A Scale Of 1 - 3

First Aid
Administrative Skills
Food Service

Rules And Agreements

Covenant Agreement

  • I will treat both the client and their property with dignity and respect.
  • I will treat all participants respectfully in accordance with the teachings of Christ. As a Christian Role Model, I will encourage all volunteers to assume leadership roles and to conduct themselves with a Christ-like attitude. I will seek to build them up and not tear them down.
  • I will show proper respect for the host church, vehicles and tools. I will conduct myself in a thoughtful, safe manner at work and at play.
  • I will participate fully in all camp activities and with a positive attitude will focus my energies to promote unity within the camp.
  • I will abide by the following vehicle regulations:
    • Seatbelts to be worn at all times
    • No youth may ride in a vehicle driven by anyone under 21 years of age
    • No riding in pickup truck beds or trailers
  • I recognize I will be relied upon to provide leadership especially at times when safety and issues of discipline are being compromised.
  • I will adhere to the following rules and regulations established by U.M. ARMY:
    • Radios, tape/disc/mp3 players, cell phones for youth are not permitted
    • Alcohol, illegal drugs and tobacco products are not permitted
    • No one may enter the dorm of the opposite sex
    • Everyone must dress appropriately
  • I will read the U.M. ARMY Travel Guide and will abide by and adhere to all that is printed within.

By checking here I acknowledge that I have read, understand and agree to the U.M. ARMY Covenant Agreement.

Press and Medical Release Terms

By checking here I acknowledge that I have read and agree to the Press and Medical Release terms. - View Here
You will need to print, sign, and turn in the Press and Medical Release Form, and the Emergency Medical Authorization to your Church Coordinator - Click Here To Download

I affirm that I am at least 18 years old; or this form has been filled out and/or approved by a parent or legal guardian.

Confirm By Entering "YES" In The Box on the right

Please correct 1 error(s)

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