Texas: Individual Registration

You're registering to go with: Deer park UMC

Your Church Coordinator Is: joel Coulter


Camp Location: Lake Charles
Camp Date: 07-07-2024 - 07-13-2024
Camp Type: High School

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

Instructions

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.

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

You will also receive an email with login information for the UMARMY.net 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...

Participant First Name*
Participant Last Name*
Participant Preferred Name*
Gender*
Date of Birth*
What race or ethnicity best describes you?*
Grade Completed at End of Current School Year
(or College/Young Adult/Adult)
Shirt Size*
Adult Sizes
Street Address*
City*
State*
Zip*
Home Phone*
Cell Phone*
Email Address*
Please List Other Family Members Attending Camp
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If registration is for youth
Parent First Name
Parent Last Name
Parent Cell Phone
Parent Email Address
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Please list two contacts, other than a Parent/Guardian, who would be allowed to pick up the participant.

1. Emergency Contact*
1. Emergency Contact Phone*
1. Emergency Contact Relationship*
2. Emergency Contact*
2. Emergency Contact Phone*
2. Emergency Contact Relationship*
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Vehicle Type
Number of Seatbelts
Drivers License #
If you have had a moving violation in the last 5 years, please describe:
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Are there any Medical Conditions or Accommodation the Safety Team needs to be aware of?
Will there be any Medications taken at camp?
We want to help you or your youth have a successful camp experience. Are there any Special, Mental, or Behavioral health needs the camp staff needs to be aware of beforehand?
Are there any Food Allergies or Special Dietary Needs the Kitchen Staff and Safety Team need to be aware of?
Are there any environmental or household allergies the leadership team needs to be aware of (i.e. animal, latex paint, poison ivy)?
Name of Medical Insurance Company*
Name of Medical Insurance Policy Holder*
Medical Insurance Policy Holder DOB*
Medical Insurance Group Number*
Medical Insurance Phone Number*
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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 - 5
First Aid*
Music*
Roofing*
Carpentry*
Administrative Skills*
Food Service*
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The below Covenant Agreement and Press and Medical Release information is new. This replaces the previous paper forms that were turned in. Please read each section carefully.

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.
  • 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 and 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 understand that camp safety is important, and I will conduct myself in a manner that keeps myself and others safe.
  • I will adhere to the following rules and regulations established by U.M. ARMY:
    • Alcohol, illegal drugs, and tobacco products are not permitted
    • No one may enter the sleeping rooms of the opposite sex
    • Everyone must dress appropriately
  • I will follow U.M. ARMY’s Cell Phone & Personal Electronics Use at Camp Policy, and only bring approved electronics to camp.
  • I will read the U.M. ARMY Travel Guide and will abide by, and adhere to, all that is printed within.
  • I am aware that all bullying, sexual harassment, and other misconduct is prohibited at any U.M. ARMY camp.

By checking here I acknowledge that I have read, understand, and agree to follow the U.M. ARMY Cell Phone & Personal Electronics Use at Camp Policy.

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

Press and Medical Release Terms

  • I wish to volunteer my services with U.M. ARMY Youth Mission Program. I acknowledge and agree that the nature of the services to be performed include but are not limited to physical labor, building repairs, yard work, construction, and the use of power tools, other construction tools, ladders, scaffolding, lawn mowers, gardening equipment and tools. I further acknowledge and agree that the services to be performed during the Program are inherently dangerous and pose a substantial risk of injury or death and of damage to or loss of personal property;
  • I acknowledge that the risks of participation also include, but are not limited to, the risks of travel; the risks of negligence, gross negligence, willful and wanton misconduct and/or bad judgment by me or other participants, including the clients, coordinators, volunteers, and site inspectors; contact with unidentified and unfamiliar persons; and the risks of failure, misuse and malfunctioning of equipment;
  • I hereby represent that I am in good physical condition and health, am capable of safely performing the activities for which I have volunteered and do not pose a risk of harm to myself or other participants;
  • I assume, to the greatest extent permitted by law, all of the risks to me, whether or not specifically identified herein, of all the activities in which I participate and the services I use and/or provide;
  • I release U.M. ARMY, its directors, officers, employees, trustees, agents, volunteers, coordinators, participants, equipment providers, and Program clients, and covenant not to sue such persons for, any and all liabilities, actions, causes of action, demands, damages (including but not limited to any illness, death, bodily injury, personal injury or property damage) and claims of every kind or nature, either in law or equity, which arise or may hereafter arise out of any activity associated with or my participation in the Program;
  • I authorize publication, broadcast or other use of my name, photograph, likeness, image, voice and biography in any and all media, publications, advertising, and publicity arising out of any activity associated with the Program without further compensation and agree that all such materials are the sole property of U.M. ARMY.
  • On behalf of myself and my heirs, I indemnify and hold harmless U.M. ARMY, its employees, trustees, volunteers, coordinators, participants, equipment providers, and Program clients from any and all costs, liabilities and claims, of every kind and nature whatsoever, arising directly or indirectly, from my participation in activities or use of services, including any legal costs and expenses and the costs of medical or other expenses incurred for my benefit.
  • I authorize any of the leaders of U.M. ARMY to obtain any and all necessary medical and/or dental attention and/or treatment for me, including surgical procedure if advised by the attending physician. I have listed on the registration form (front side), any and all special medical problems concerning myself, and I confirm that I have advised the leaders of U.M. ARMY of any special medical problems.

By checking here I acknowledge that I have read and agree to the Press and Medical Release terms.

I certify I have been, or will be prior to the start of the camp for which I am registering, trained according to my church's Safe Sanctuary or Ministry Safe Policy, or equivalent policy or guidelines. In the event I am not attending with a church, I certify I have a Safe Sanctuary or Ministry Safe Certification or equivalent, and a copy of a completed background check, or will complete both the training and criminal background check prior to the start of the camp for which I am registering, and will submit both to either my Camp Directory or Regional Director.

I Agree (Required if 18 years of age or older)

Signature
By my signature below I acknowledge that I have read, understand and agree to the U.M. ARMY liability, press and medical release above. I have also read the Covenant of Conduct above and agree to abide by it. I affirm that all the information on the U.M. ARMY Individual Registration form is correct.


A value is required.
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