Summer Camp Pre-registration Form

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Registration Fees will be paid through PayPal and must be completed in order to complete registration process online. YOU DO NOT need to have a PayPal account to use this system and may use credit card or debit card. If you do not have a Paypal account you may sign in as a "guest".
Only one camper may be registered at a time.
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Camper's Full Name* This field is required.
First Name
Last Name
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
United States
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Birth Date* This field is required.
Month
Day
Year
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Current Age:* This field is required.
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Gender:* This field is required.
Male
Female
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Phone Number* This field is required.
Area Code
Phone Number
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E-mail Address where you'd like to receive confirmation and information:* This field is required.
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Camp Session camper is registering for:* This field is required.
Please Select
Please Select
8th and 9th Grade June 18-23
6th and 7th Boys June 25-29
6th and 7th Girls July 9-13
4th and 5th Boys July 16-20
4th and 5th Girls July 23-27
High School (10th-graduate 2012) July 27-30
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Grade Entering Fall 2012* This field is required.
Please Select
Please Select
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Graduated 2012
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What church do you attend:
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Please provide at least 2 emergency conacts.
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1st Emergency Contact Name* This field is required.
First Name
Last Name
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1st Emergency Contact Relationship:* This field is required.
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1st Emergency Contact Daytime Phone Number:* This field is required.
Area Code
Phone Number
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1st Emergency Contact Evening Phone Number if different:
Area Code
Phone Number
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2nd Emergency Contact Name:* This field is required.
First Name
Last Name
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2nd Emergency Contact Relationship:* This field is required.
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2nd Emergency Contact Day Phone Number:* This field is required.
Area Code
Phone Number
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2nd Emergency Contact Evening Phone Number if different:
Area Code
Phone Number
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Please list other important emergency contacts, their relationship to camper, best phone numbers or other contact information that will be helpful in an emergency.
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Doctors Name or Medical Clinic:* This field is required.
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Doctor's Phone Number:
Area Code
Phone Number
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List any medical food allergies: (If none, enter none)* This field is required.
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List any chronic illness and or physical limitaitons camp should know about: (If none, enter none)* This field is required.
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Date of last tetanus shot:* This field is required.
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List all current medications: (If none, enter none)* This field is required.
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Is camper covered by medical insurance:* This field is required.
Yes
No
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Name of Insurance Company (enter none if no insurance):* This field is required.
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Policy Number (enter none if no insurance):* This field is required.
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I, as the registered am 18 or over, or I am a parent or legal guardian of the registered who is currently under the age of 18, grant permission for the registered camper to attend Camp Utmost and consent to its Discipline Policy and also do hereby release Camp Utmost and Rocky Mountain Bible Mission from any and all liability or responsibility due to any injury that he/she/I may incur as the result of, or arising in any way from participation in activities at or under the direction of Camp Utmost. I am fully aware and consent to accept these risks and voluntarily agree to allow his/her participation in activities. If I cannot be consulted in an emergency, I hereby give permission to the physician selected by a representative of Camp Utmost to hospitalize, secure treatment for, and to order injections, anesthesia, and/or surgery for the person named above. I understand that Camp Utmost only carries secondary insurance and that I will take primary responsibility for any fees or charges at any clinic, facility, or hospital arising from treatment of injury or illness. I furthermore understand Camp Utmost often takes photographs or videos of participants during its activities or events. I grant permission without compensation that these photographs or videos may be used in publications, presentations, websites or promotion of Camp Utmost or Rocky Mountain Bible Mission. Camp Utmost will not identify me or my child by name, or release any other personal information without additional written permission from me.
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Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be 18 years old or over to sign below.)* This field is required.
First Name
Last Name
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Relationship to registered camper:* This field is required.
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Current Date:* This field is required.
Date
Month
Day
Year
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Click Only One Camp Session. Camp rates increase $10, 10 days before each camp starts. Optional Items are also listed. You may also pay for bus transport, add funds to camp store, pre purchase products or make a donation.* This field is required.
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My Bag
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$20
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Size:Small
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ORDER SUMMARY
Total costUSD
Utmost 8th & 9th Grade, June 18-23 (Regular Registration Rate)
$100.00Edit
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Utmost 6th & 7th Grade Boys, June 25-29 (Early Registration Rate)
$90.00Edit
Back
Utmost 6th & 7th Grade Girls, July 9-13 (Early Registration Rate)
$90.00Edit
Back
Utmost 4th & 5th Grade Boys, July 16-20 (Early Registration Rate)
$90.00Edit
Back
Utmost 4th & 5th Grade Girls, July 23-27 (Early Registration Rate)
$90.00Edit
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Utmost High School Camp (10th - Grad. 2012), July 27-30 (Early Registration Rate)
$75.00Edit
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Bus Transport (Stops in Lolo, Missoula & Bonner). Round trip or one way is the same fee.
$10.00Edit
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Choose Bus Stop Location
Choose Bus Stop Location
Lolo Community Church
7 R's Store (Reserve St N. of I90)
Bonner (Town Pump)
Bus Stop Location
Add Funds To Camp Store Account (check box and choose an amount)
$1.00Edit
Back
0
0
5
10
15
20
25
Check $ amount to add
Purchase 2012 T-Shirt
$12.00Edit
Back
Purchase Metal Utmost Logo Water Bottle
$10.00Edit
Back
Purchase Plastic Utmost Logo Water Bottle
$5.00Edit
Back
Purchase Stainless Steel Utmost Logo Travel Mug
$7.00Edit
Back
I would like to make a donation to help a another camper be able to attend Camp Utmost
$1.00Edit
Back
0
0
1
5
10
25
50
75
100
Check Amount of Donation
Total $0.00
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For Security, type the message seen below:* This field is required.
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An 80% refund of camp fee is made if notice is given to Camp Utmost by the early registration deadline of that camp. A 50% refund is made if notice is given to Camp Utmost no later than the beginning of that camp. No refund will be made once the camp starts. Canceled online store deposits and merchandice purchases will be refunded at 95% to compensate for fees Camp Utmost has to pay.
All refunds are processed after the camp ends. We do not prorate fees for attending only a part of the camp week.
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Upon completion of filling in all areas of form, click "Submit Form". You will then be taken to PayPal where you will pay and registration process will be completed. Only one camper may be registered at a time. You may click "Print Form" to print a copy of this form. Please also print "Camper/Parent page for needed information.Do you have questions or need help with online registration? Email Lloyd at camputmost@gmail.com.
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