Luccock Senior High Camp ~ August 6 - 11, 2017

Contact First Name
Contact Last Name
Contact Email
*First Name *Last Name *Email
Email Addresses -- You may provide up to two additional email addresses to receive camp information from the camp dean approimately 7 - 10 days in advance of camp.
*Preferred Name

Please provide the name the camper would want on his/her badge.  This can be the name as regitsered, a shorted name, or a nickname.

*Mailing Address


*Zip Code
*Date of Birth -- mm/dd/yyyy
*Grade in the Fall of 2017
*1st time at camp?
No, my child has camped with YAC Camping before
Yes, but my child has been away from me overnight before
Yes, first time to camp and first overnight away from home
Home Church

If you are attending a United Methodist Church in the Yellowstone Conference, please select it here -- listed alphabetically by town/city.

If your church was not listed, please provide church name and city below.
Pastor Please enter your pastor's name here.
Emergency Contact information!
*Parent or Guardian
*Phone Number -- please enter as xxx-xxx-xxxx.
Alt Phone Number - please enter as xxx-xxx-xxxx.
*Emergency Contact Person (other relative or friend)

Someone who knows the camper/family well and can serve as a back up emergency person

*Phone Number - please enter as xxx-xxx-xxxx.
Alt Phone Number -- please enter as xxx-xxx-xxxx.
Required: Camper Questions & Medical Info

In order for us to properly care for this camper, we need the most up to date medical care information. This information will be forwarded to the camp dean and camp manager and must be completed for registration to be processed. If your answer is "none," or "not applicable," please note that in the box.  If you are registering multiple campers, you must answer the questions for each camper.  Thank you.

*Camper Full Legal Name

As provided for medical care & insurance

*Insurance Policy Provider As listed on insurance card
*Insurance Policy Number As listed on your insurance card
*Medical Provider Name and Phone number

Contact information for your camper's regular doctor.

Please check boxes below as appropriate regarding food allergies or dietary restrictions (i.e. peanut allergy, gluten free, vegan).

Food Allergy

My camper has food allergies.  I have listed all allergies in the text box below, including information about symptoms to watch out for and treatment methods, medications, etc.  

Special diet

My camper has special dietary needs.  I have identified these in the text box below, including how the dietary needs are managed at home.

If you checked the food allergy or special diet box above, please provide all necessary information so that we can ensure that your camper can be healthy and active at camp.
My camper has no known food allergies and no dietary restrictions. Please check this box only if you have not checked one of the above.
General Health
Physical Conditions

Please note any physical conditions to which the camper is suseptible or is currently experiencing and any limitations that may keep your camper from fully participating at camp (headaches, back pain, etc.).  Please note any other conditions (homesickness, hyperactivity) that may affect his/her experience at camp.


List any medications, prescription or non-prescription, the camper will bring to camp and any special dosage information or requirements (i.e. with food, # of times a day, before bedtime. etc).

Specific Care Requirements

If your camper has specific care requirements / diagnoses (ADD/ADHD, seizures, social issues, limited direct sunlight, sleep disorder, etc.) please note what they are and how you manage care at home.

Anything else we should know?

This section is for you to tell us anything that may be helpful. Additionally, are there any recent significant events in this camper's circle of family or friends (divorce, death, etc.) that may impact his/her camp experience?

I agree.

By checking this box, you are indicating to us that the information you have provided is correct to the best of your knowledge as of the date you submit your registration. If anything changes before camp, you agree to inform us by email at or in person at camp registration.

*Photo/Media Release

I give permission for photographs, video, or other images of the youth to be used by the Yellowstone Annual Conference or Luccock Park United Methodist Camp for the website or other publicity, printed or electronic.

I have read and shared this 2017 Covenant with my camper.

This covenant is an agreement between everyone at the retreat – about how we will live together. 

Please read it carefully.

This event is an experience in Christian living. Therefore, I am willing to assume these responsibilities, which will require certain behavior the entire time I am at camp.

I will be responsible for myself and the following:

• I will be honest and expect the same of others.

• I will attend all scheduled activities and meet time commitments unless excused by an adult staff or chaperone.

• I will go to bed, stay in bed, and be quiet from lights out until scheduled wake-up.

• I will take no unnecessary risks nor will I encourage others to do so.

• I will stay drug, alcohol, and tobacco free, except for prescription drugs listed on my medical consent and over-the-counter drugs provided by adult staff or chaperones.

I will be responsible for others by agreeing to the following:

• I will take into consideration the rights and feelings of others and respond to them in a loving manner.

• I will practice good stewardship by respecting the possessions of others and the facilities where we stay.

• I will avoid being loud, crude, and vulgar because such behavior intrudes upon others.

• I will be a positive influence on others.

Consequences for breaking this covenant will be determined by adult staff and may include:

• I will pay for any damage I cause.

• I am aware that legal authorities will be called if I act unlawfully.

• I will provide my own ride home if required to leave.

• I am willing to commit to this covenant so our retreat will be a safe, positive growing experience for everyone.

I have read this statement and faithfully promise to abide by it. I understand that should I not abide by it, I will be responsible for my actions and will accept my consequences.


We recommend a $50 down payment to hold your place.  Please click here to review the cancellation policy posted on the Luccock Park Camp website.

*Camper Fee

As you consider your family’s financial situation, please also consider the true cost of camp.  You get to choose the tier that best fits your family’s ability to pay.  Each camper receives the same high quality experience, regardless of the amount paid.

•    Tier 1 is the actual cost of camp and provides an additional $50 to help other campers registered at a discounted rate.

•    Tier 2 is the actual cost of the camp.

•    Tier 3 is a discounted rate.

This serves as an agreement to pay.  Payment options include:

  • Online by credit card -- You will be redirected to a payment page when you click "Submit" below.
  • Check -- Send your check to Luccock Park Camp, c/o Gail Tronstad, PO Box 803, Helena, MT   59624. To ensure proper accounting you must include camper name and the camp attending.
Tier I Camper Fee (pays your full cost and helps another camper attend) ($399)
Tier II Camper Fee (pays your full cost) ($349)
Tier III Camper Fee (discounted cost for you) ($299)
Tier I Camper Fee (pays your full cost and helps another camper attend): There are only 179 available
Tier II Camper Fee (pays your full cost): There are only 172 available
Tier III Camper Fee (discounted cost for you): There are only 171 available
Comments or Camp Payment Notes

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