PVCC Summer Camp Parental Release / Medical Information

Prairie View Christian Camp 2024 Registration

Step 1: Complete this online form.

Parental/Volunteer Consent
Recreation Options

I understand that participants attending a camp session at Prairie View Christian Camp will be offered an opportunity to participate in multiple recreation options including, but not limited to, swimming, paintball, rock climbing, rappelling, and zip line. Additionally, Junior High and High School participants may be offered an opportunity to Trap Shoot. I fully understand and acknowledge that 1. risks and dangers exist in the participation in and use of high ropes elements; 2. that participation in such activities and/or use of such equipment may result in injury or illness including, but not limited to, bodily injury, disease strains, fractures, partial and/or total paralysis, eye injury, blindness, heat stroke, heart attack, death, or other ailments that could cause serious disability; and 3. by giving my child permission to participate in these activities and use this equipment, I assume all risks and dangers and all responsibility for any losses and/or damages incurred while participating in these activities.
Medical Treatment Permissions

To the best of my knowledge, my child is physically and emotionally able to take part in the camp program. In the event of a medical emergency, I give permission to the volunteer medical person selected by the camp management to do whatever is necessary for the health of my child as named on this form. I hereby release the camp from any responsibility other than normal supervision and care. In case of an accident, I will not hold Prairie View Christian Camp, their staff members, management, or officers liable. I have reviewed this form and certify that all appropriate medical information is included.
Camp Content and Behavior Agreement

I recognize that this is a Christian camp, that the Bible will be studied, and that camp conduct will be expected that is consistent with Christian Values.
I also give my permission for any appropriate photographs/videos to be used for future Prairie View Christian Camp promotional purposes.

YesNo
The Zip Line Weight Limit is 250 lbs. The participant's weight is below 250 lbs.

YesNo

Parent Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email Address:
example@example.com
Parent/Guardian Phone Number:*

Area CodePhone Number

Emergency Contacts
Please list someone other than the parent/guardian listed above.
Primary Contact: In case of emergency, please contact the following person *

First NameLast Name
Primary Contact relationship to student*
Primary Contact Home Phone Number*

Area CodePhone Number
Primary Contact Cell Phone Number*

Area CodePhone Number
Primary Contact Work Number

Area CodePhone Number
Secondary Contact: In case of emergency, please contact the following person

First NameLast Name
Secondary Contact relationship to student
Secondary Contact Home Phone Number

Area CodePhone Number
Secondary Contact Cell Phone Number

Area CodePhone Number
Secondary Contact Work Number

Area CodePhone Number

Payment Information
Please choose your camp and church affiliation below. The price reflected is the full price of camp, any discounts will be applied as selections are made.

PAYMENT IS FOR ONLY THE PERSON BEING REGISTERED ON THIS FORM.

Camp Fees

High School Camp - Camper$375.00

June 2 - June 7

Church Attending With HS

Middle School Camp - Camper$375.00

June 9 - June 14

Church Attending With

Junior Camp - Camper$225.00

June 17 - June 20

Church Attending With

Hybrid Camp - Camper$225.00

June 23 - June 26

Church Attending With

Kid's Camp - Camper$150.00

June 26 - June 28

Church Attending With

First Timer’s Camp - Camper$75.00

June 21 - June 22

Church Attending With

Day Camp - Camper$65.00

June 22

Church Attending With

High School Camp - Adult Volunteer $100.00

June 2-7, 24

Quantity

High School Camp - Non Camper Child of a Volunteer age 11 and above$100.00

June 2-7, 24

Quantity

High School Camp - Non Camper Child of a Volunteer age 5-10$50.00

June 2-7, 24

Quantity

Middle School Camp - Non Camper Child of a volunteer age 11 or above$100.00

June 9-14, 24

Quantity

Middle School Camp - Non Camper Child of a volunteer age 5-10$50.00

June 9-14, 24

Quantity

Middle School Camp - Adult Volunteer$100.00

June 9-14, 24

Quantity

Junior Camp - Adult Volunteer$60.00

June 17-20, 24

Quantity

Junior Camp - Non Camper Child of a volunteer age 11 or above$60.00

June 17-20, 24

Quantity

Junior Camp - Non Camper Child of a volunteer age 5-10 $30.00

June 17-20, 24

Quantity

First Timer's Camp - Parent or Adult Volunteer $20.00

June 21-22, 24

Quantity

First Timer's Camp - Non Camper Child age 5-10 or above$20.00

June 21-22, 24

Quantity

First Timer's Camp - Non Camper Child age 11 or above$10.00

June 21-22, 24

Quantity

Day Camp - Parent or Adult Volunteer $10.00

June 22, 24

Quantity

Day Camp - Non Camper Child age 11 or above$10.00

June 22, 24

Quantity

Day Camp - Non Camper Child age 5-10.$5.00

June 22, 24

Quantity

Hybrid Camp - Adult Volunteer $60.00

June 23-26, 24

Quantity

Hybrid Camp - Non Camper Child age 11 or above.$60.00

June 23-26, 24

Quantity

Hybrid Camp - Non Camper Child age 5-10$30.00

June 23-26, 24

Quantity

Kid's Camp - Adult Volunteer $40.00

June 26-28, 24

Quantity

Kid's Camp - Non Camper Child age 11 or above$40.00

June 26-28, 24

Quantity

Kid's Camp - Non Camper Child age 5-10$20.00

June 26-28, 24

Quantity

Enter coupon

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

The box next to the country is for your zip code. Please enter it in that box before proceeding.

Parent/Guardian Signature
By signing this form I affirm my answers to the statements and questions as answered above. If not signed, the camper or adult volunteer will not be allowed to participate in a camp session.

I have read and understand the statements in this release form. I understand that should a health problem arise, I will be notified but if I cannot be reached by telephone I consent to emergency medical treatment, which may include surgery for my child as deemed necessary by competent medical personnel. I also consent to the release of information for insurance purposes.
Parental Consent: Parent/Guardian Signature*

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Date of Signature*

MonthDayYear
Date
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Prairie View Christian Camp 2024 Registration