SERVE Weekend Registration

2023 SERVE Weekend Registration

Families/all ages (minors attend with parents). FREE!
Family Information
Head of Household*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*

Confirmation Email
Home Church

List each member of your family (including yourself)*

	First Name	Age	Category
Family Member 1
Family Member 2
Family Member 3
Family Member 4
Family Member 5
Family Member 6
Family Member 7
Family Member 8

Please select your accommodations in order of preference*

	1st Choice	2nd Choice	3rd Choice
Lower Camp Cabin
RV/Tent Site
Hillside Camp Cabin

Lodging is in bunkroom units with 10 beds each. If necessary, we may combine two or more families in the same unit. Please list any families with whom you would like to be housed with.
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.

Please select the meals you and your family will be eating:

	Breakfast	Lunch	Dinner
Friday (dinner only)
Saturday
Sunday
Monday (breakfast and lunch only)

Do you and/or any of your family members have allergies, chronic illness, or medical conditions you would like us to be aware of?*

YesNo
If yes, please describe allergies, chronic illness, or medical conditions here:
Informed Consent and Acknowledgement

My family and I are fully aware of inherent hazards and risks. We choose to participate voluntarily and assume all risks of losses, damages, and injuries.

GENERAL RELEASE AND WAIVER
Recreational activities and use of the Pleasant Valley Christian Camp (PVCC) facilities and grounds include, but are not limited to, the following: volunteer work projects, laser tag; basketball, baseball, soccer, and volleyball; hiking trails; swimming pool; field games; archery; group games; campfires; arts and crafts; drama; music; athletic activities; limited transportation on and off the grounds, etc. I agree that my family and I are physically able to participate in all camp activities based on a physician’s examination.

In exchange for being allowed to participate in volunteer work projects, recreational activities and use of the facilities and grounds at PVCC, my family and I and our 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, death, 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 the 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 audio recordings of my family and me 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

I hereby authorize diagnosis and treatment by a qualified and licensed medical professional for my family members and me in the event of a medical emergency, which in the opinion of the attending medical professional requires immediate attention to prevent further endangerment of life, physical disfigurement, physical impairment, undue pain, suffering, or discomfort.

Permission is hereby granted to the attending physician to proceed with any examinations and medical or surgical treatment.

Permission is also granted to Pleasant Valley Christian Camp and its affiliates, including Program Staff and Camp Staff, to provide needed emergency treatment prior to 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 my family members and me.

Optional Donation

USDDescription

Credit Card

Confirmation

BY SUBMITTING THIS REGISTRATION, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT HAS THE SAME LEGAL EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Stay on this page until it shows that your submission has been received. Please check your email inbox for a confirmation email from Jotform; if you don't see it, check your spam/junk mail folder as well. Contact us at office@pleasantvalleycamp.org if you do not receive a confirmation email.
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2023 SERVE Weekend Registration

NOTE: We cannot accommodate special dietary preferences.

Credit Card