High School Camp Registration

DISCOUNTS AND SCHOLARSHIPS AVAILABLE:

Partner Church Discount: Save 50% on registration! If your congregation participates in our church partnership program to support the camp, ask your pastor or youth minister for a discount coupon code to enter when you register.

PVCC Scholarships: To apply for a full or partial camp scholarship, please go to pleasantvalleycamp.org/scholarships before registering. If your application is approved, you will receive a scholarship coupon code to enter when you register.
Junior Retreat Registration

February 17-20, 2023 | Grades 4-6 | $139 per camper
Camper Information
Camper Name*

First Name Last Name
Grade*

456
Birth Date*

Month Day Year
Gender*

MaleFemale
T-Shirt Size*
Address*

Street Address

Street Address Line 2

City State

Zip Code
Home Church
Preferred Cabin Mates (List up to three)
Parent/Guardian Information
Parent/Guardian Name*

First Name Last Name
Parent/Guardian Phone Number*

Area Code Phone Number
Parent/Guardian E-mail*

Confirmation Email
Emergency Contact Information
Emergency Contact Name*

First Name Last Name
Emergency Contact Relationship*
Emergency Contact Phone Number*

Area Code Phone Number
Emergency Contact Alternate Phone Number

Area Code Phone Number
NOTE: We cannot accommodate special dietary preferences.

Please reach out to our camp manager Logan Jenott at 360-492-3451 or office@pleasantvalleycamp.org with questions or concerns about severe food allergies.
Informed Consent and Acknowledgement

As the parent or legal guardian of the registered participant, I attest that I am fully aware of inherent hazards and risks. I elect to allow my child to participate voluntarily and assume all risks of loss, damage, or injury that may be sustained.

GENERAL RELEASE AND WAIVER
Recreational activities and use of the Pleasant Valley Christian Camp (PVCC) grounds include, but are not limited to, the following: laser tag and equipment; basketball, baseball, soccer, and volleyball courts or fields; hiking trails; swimming pool; field games; archery; group games; campfires; arts and crafts; drama; music; a variety of athletic activities; limited transportation on and off the grounds, etc. As the parent or legal guardian of the registered participant, I agree that my child is physically able to participate in all camp activities based on a physician’s examination.

In exchange for the registered camper being allowed to participate in recreational activities and use of the grounds at PVCC, the parent or legal guardian and personal representatives, assigns, heirs, and next of kin hereby release, hold harmless, indemnify and defend PVCC (including its agents, employees, and representatives) from any and all liability for injury or damages including, but not limited to, bodily injury, personal injury, emotional injury, or property damage which may result from any person using the above-described property and participation in any activities, unless such injury or damage results from intentional, willful, or reckless acts by PVCC (including its agents, employees, and representatives).

IMAGE RELEASE AND WAIVER.
I give permission to PVCC to use any photographs, videos, and/or audio recordings of the registered participant for promotional materials, including the PVCC website and social media, without expectation of compensation, including, but not limited to, any royalties, proceeds, and/or other benefits derived from such photographs, videos, or audio recordings.
Medical Release and Authorization

As the parent and/or legal guardian of the registered participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional of my child in the event of a medical emergency, which in the opinion of the attending medical professional requires immediate attention to prevent further endangerment of the registered participant’s life, physical disfigurement, physical impairment, or other undue pain, suffering, or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or surgical treatment and x-ray examination for the registered participant. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me as quickly as possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Pleasant Valley Christian Camp and its affiliates including Directors, Counselors, and Camp Staff to provide the needed emergency treatment prior to the registered participant’s admission to a medical facility.

Release authorized on the dates and/or duration of the registered program.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the registered participant, in my absence.

Camp Fees*

Registration$139.00

Canteen credit for snacks, drinks, T-shirts, hoodies, merchandise, etc.$5.00

You may select multiples of $5 (up to $100) in canteen credit. Unspent money can be refunded or donated to selected missions.

Quantity

Enter coupon

Total $0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Confirmation

BY SUBMITTING THIS REGISTRATION, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Should be Empty:

Junior Retreat Registration

Emergency Contact Information

NOTE: We cannot accommodate special dietary preferences.

Payment Methods