Northeast: Single Individual Registration

"Use this form ONLY IF you are registering as an individual that is NOT part of a registered church group."

Instructions

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

The form to the right has 8 Sections:

  • Your Personal Information
  • Parent Information (if applicable)
  • Emergency Contact Information
  • Vehicle Information (if applicable)
  • Medical Information
  • Camp 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.

 

 

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...

 

Personal Information

Participant First Name
A value is required.
Participant Last Name
A value is required.
Participant Preferred Name
A value is required.
Gender
Date of Birth

Format: mm/dd/yyyy

A value is required.
Grade Completed at End of Current School Year

If applicable

Shirt Size

Adult Sizes

Street Address
A value is required.
City
A value is required.
State
Zip
A value is required.
Home Phone
A value is required. If you do not have a home phone, please enter cell, or other primary phone number.
Cell Phone
Email Address A value is required.
Please List Other Family Members Attending Camp

Parent Information

If registration is for youth

Parent First Name
Parent Last Name
Parent Cell Phone

Emergency Contact Information

Please list two contacts, other than a Parent/Guardian, who would be allowed to pick up the participant.

1. Emergency Contact A value is required.
1. Emergency Contact Phone
A value is required.
1. Emergency Contact Relationship A value is required.
2. Emergency Contact A value is required.
2. Emergency Contact Phone
A value is required.
2. Emergency Contact Relationship A value is required.

Vehicle Information

Required if bringing vehicle to be used at camp

Vehicle Type
Number of Seatbelts

Medical Information

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 your student 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?
Name of Medical Insurance Company
Name of Medical Insurance Policy Holder
Medical Insurance Policy Holder DOB
Medical Insurance Group Number
Medical Insurance Phone Number

Camp Information

Special Requests (distance limits, with a specific church, etc.)
Week - First Choice
Week - Second Choice

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
Music
Roofing
Carpentry
Administrative Skills
Food Service

Rules And Agreements

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. You must agree to the terms of the Cell Phone & Personal Electronics Use at Camp Policy to attend U.M. ARMY mission trips.

By checking here I acknowledge that I have read, understand and agree to the U.M. ARMY Covenant Agreement. You must agree to the terms of the covenant agreement to attend U.M. ARMY trips.

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.
You must agree to the terms of the press and medical release to attend U.M. ARMY camps.

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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