2024 Camp Utmost Winter Retreat

Winter Youth Retreat Registration

Join us February 2-4 for our Limitless Winter Youth Retreat! The retreat begins 5:30 PM Friday and ends 1:30 PM Sunday. Early Bird pricing ends January 12. The retreat is open to grades 7-12. 6th graders are welcome if they attend with a youth group. Counselors needed!
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.
Camper's Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Grade Currently In *
Current Age:*
MaleFemale
Phone Number*
Format: (000) 000-0000.
E-mail Address (for confirmation and information):*
example@example.com
Home Church (if applicable):
Cabin Roommate Requests: Please list full names of up to 2 friends to room with. Friends must register online within a week.
Emergency and Medical Information
1st Emergency Contact Name*

First NameLast Name
1st Emergency Contact Relationship:*
1st Emergency Contact Daytime Phone Number:*
Format: (000) 000-0000.
1st Emergency Contact Evening Phone Number if different:
Format: (000) 000-0000.
2nd Emergency Contact Name:*

First NameLast Name
2nd Emergency Contact Relationship:*
2nd Emergency Contact Day Phone Number:*
Format: (000) 000-0000.
2nd Emergency Contact Evening Phone Number if different:
Format: (000) 000-0000.
Please list other important emergency contacts, their relationship to camper, best phone numbers or other contact information that will be helpful in an emergency.
Doctor's Name or Medical Clinic:*
Doctor's Phone Number:
Format: (000) 000-0000.
List any medical allergies (if none, enter none):*
List any food allergies or intolerances (if none, enter none):*
List any chronic illness and or physical limitations camp should know about (if none, enter none):*
Date of last tetanus shot:*
List all current medications: (If none, enter none)*
YesNo
Name of Insurance Company (enter none if no insurance):*
Policy Number (enter none if no insurance):*
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.)*

First NameLast Name
Relationship to registered camper:*
Current Date:*

MonthDayYear
For Security, type the message seen below:*
Payment

Registration Payment*

Winter Retreat Registration

$90.00

Enter coupon

Total

$0.00

Completing Registration

Upon completion of the form, click "Submit Form". You will then be taken to PayPal where you will pay and registration process will be completed. You will then receive a confirmation via email.

Do you have questions or need help with online registration? Email Kimmy at camputmost.dailey@gmail.com

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Winter Youth Retreat Registration

Emergency and Medical Information

Payment