All those registering for Horsemanship Camp MUST call Steve Miller (435) 671-8743

3. Medical Information
If your child has a medical need or problem, PLEASE enclose a note and attach it to the registration form. The Camp provides limited SECONDARY medical insurance that requires a $100 deductible which you must pay if used. It does not cover illness. The parent or guardian MUST still provide the primary medical insurance. It is also necessary in case of an emergency where immediate medical care is needed for you to sign the following statement:

"In the event I am unavailable at the time my child is at Camp, I hereby give my permission to any physician the Camp chooses to perform any emergency medical treatment (including surgery) as may be necessary for my child."
Signature of Parent or Guardian  ______________________________________ Date 

Emergency Phone Number  

     Drug Allergies or Other Allergic Reactions:

     Regular Medication:

     Activity Restrictions:  

     Insurance Company     Policy # 

4. Release of Liability

Camp Utibaca offers many exciting activities such as horseback riding, rappelling, climbing tower, shooting, archery, hiking crafts (involving hand and power tools) and group games. The Camp Staff will try to make these activities as safe and enjoyable as possible. None of these supervised activities are required, but are available to Campers by choice. However, knowing that any such activities may have a potential risk and hazard, we kindly ask you to sign the following statement to help conserve the investment of God's people in this Camp:

"I give permission for my child to attend Camp Utibaca and to engage in all Camp activities. I also hereby release Camp Utibaca, its Staff and all others connected with the program from any liability from any injuries to my children. I further agree not to consider any property nor assets of Camp Utibaca or it's Staff as possible payment for any injuries to my child."
     Signature __________________________________________________________________ Date 

Upon receipt of this form, further instructions about what to bring will be sent to you.

IMPORTANT: Please notify the Camp if your child has been exposed to any communicable disease during the  two weeks prior to Camp attendance.
5. Amount Enclosed: $10 Registration Fee (non-refundable, goes toward Total Fee) $75 Horsemanship Registration Fee (non-refundable) $100 Total Fee if postmarked on or BEFORE June 1 $110 Total Fee if postmarked AFTER June 1 $25 Total Fee for Staff Training Camp (Bible College Students Exempted) $75 Total Fee (Leadership Training Camp) $75 Total Fee (Staff Training Camp & SrHi Camp) $190 Total Fee (Horsemanship Camp)