Registration

Purpose of the Young Men’s Ultimate Weekend
To provide young men a weekend filled with incredible fun and challenges,
while building a foundation for a confident and successful adulthood,
through learning the importance of teamwork, developing a
sense of accomplishment and acquiring leadership skills.

Tuition Information

Tuition is $150.00 if paid 21+ days prior to the Weekend start date (May 27th for June Weekend and June 16th for August Weekend). Tuition is $200.00 if paid within 20 days of the start date. No personal checks accepted within 7 days of the event and tuition must be paid in full prior to participation. No refund policy within 7 days of the start date but can be credited toward any future YMUW events. An additional $25 will be charged for returned checks. If paying by credit/debit card, you can do so at www.YMUW.org or contact us for a credit/debit payment form. Please check your payment method below.

If you prefer to register by mail, download the registration form otherwise complete the online form below.

2011 Weekends June 17-19
YMUW 		Aug. 12-14
YMUW
     
How did you hear about YMUW? If Other
     

PARTICIPANT PERSONAL INFORMATION
Last Name:  
First Name:  
Address:  
City: State: Zip:
Home Phone: Work Cell:
E-mail:
Grade Level: Date of Birth: Age:

List any physical, psychiatric or medical conditions
we should know about:
 
 

PARENT/GUARDIAN INFORMATION
I have read, and agree the attached Terms and Conditions: Terms & Conditions PLEASE READ CARELFULLY
     
Parent/Guardian Name:

Address:
(if different from participant)
Relationship to participant:

     
Home Phone: Work: Cell:
     
E-Mail:
Emergency Contact:
Emergency Phone:
 

SPONSOR INFORMATION (optional)
Sponsor Name:
Home Phone: Work: Cell:
 
Address:  
E-Mail:  
Organization:  
     
 

PARTICIPANT MEDICAL INFORMATION
Doctor's Name:
 Doctor's Phone:  
Insurance Carrier Name:
    
Insurance/Group Plan #:
ID#:  
 
List any medication you will be taking during the weekend:
Special dietary requirements:
Allergies:

 

Check all items that apply, past or present, to your health history. Please explain any checked items.
  Asthma  
  Diabetes  
  Kidney Disease  
  Cancer/Leukemia  
  Heart Trouble  
  Convulsions  
  Hemophilia  
  Seizures  
  High Blood Pressure  

Please Explain:


List any physical or behavioral conditions that may affect or limit full participation in swimming, backpacking, hiking or strenuous physical activities:

Do you have a history of walking in your sleep?


List special equipment needed such as wheelchair, braces, glasses, contact lenses, etc.

 
 

MY COMMITMENTS AS A PARTICIPANT

  1. I understand the Young Men’s Ultimate Weekend may take place in a wilderness setting and will be physically demanding. I will give my best to this challenge.
  2. I will not bring any electronic equipment, non-prescription drugs, illegal materials, weapons, tobacco or alcohol. I will not smoke tobacco/anything during this event.
  3. I will ensure the safety for myself and other young men at all times.
  4. I am enthusiastic about this weekend and I agree to participate fully with a positive attitude!
  5. I understand I am making a commitment to be prepared for and attend the Young Men’s Ultimate Weekend.
  6. I understand that I may be removed from the Weekend if I fail to comply with any of these commitments.

I have read, and agree and agree to these commitments.
When you have completed the Registration application, please click on the "Make Payment" button below.  Thank You.

 


Home  About Us The Weekend Family Services Volunteer  Donate

North Bay - info@ymuw.org, South Bay - southbay@ymuw.org
(800) 719-9302