2025 Junior Camp Registration

DISCOUNTS AND SCHOLARSHIPS AVAILABLE

Church discounts and scholarships: Ask your pastor or youth pastor if your home church supports PVCC through our partnership program. If so, they can provide you with a partner church discount code to enter at payment on the registration form. Your church may also offer need-based camp scholarships; ask your pastor or youth pastor how to apply.

50% PVCC scholarship: If you need help paying for camp and your church does not offer a discount or scholarship, please go to pleasantvalleycamp.org/scholarships to apply for a 50% scholarship. If your application is approved, you will receive a coupon code for 50% off to enter at payment on the registration form below.

Please fill out and submit both this registration form and the embedded child camper medical form in their entirety. Your child is considered registered when you receive confirmation emails for both forms.

Camper Information

Camper Name*

First NameLast Name

Grade*

456

Birth Date*

MonthDayYear

Gender*

MaleFemale

T-Shirt Size*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Home Church

Preferred Cabin Mates (List up to three)

We will do our best to accommodate requests, but cannot guarantee cabin placement.

Parent/Guardian Information

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Phone Number*

Area CodePhone Number

Parent/Guardian E-mail*

Confirmation Email

Emergency Contact Information

Emergency Contact Name*

First NameLast Name

Emergency Contact Relationship*

Emergency Contact Phone Number*

Area CodePhone Number

Emergency Contact Alternate Phone Number

Area CodePhone Number

Please fill in your camper's medical and emergency information in the embedded medical form below. After you submit the medical form, please continue to the bottom of the registration form for payment and to submit your registration.

Informed Consent and Acknowledgement

As the parent and/or legal guardian of the registered participant, I am fully aware of inherent hazards. I voluntarily allow my child to participate at Pleasant Valley Christian Camp. I assume responsibility for all risks of loss, damage, injury, or death.

GENERAL RELEASE AND WAIVER
Pleasant Valley Christian Camp activities may include (but are not limited to): basketball, baseball, soccer, volleyball, field games, hiking, swimming, archery, campfires, arts and crafts, drama; music; playground, 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.

The parent or legal guardian and personal representatives, assigns, heirs, and next of kin of the registered participant hereby release, hold harmless, indemnify and defend Pleasant Valley Christian Camp (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.

IMAGE RELEASE AND WAIVER.
I give permission to Pleasant Valley Christian Camp to use any photographs, videos, and/or audio recordings of the registered participant for printed and online promotional materials, including 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 authorize diagnosis and treatment by qualified and licensed medical professionals 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.

I give permission to the attending medical professional 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 accidental injury, I understand that every attempt will be made by the attending medical professional to contact me as quickly as possible and that this authorization is granted only after a reasonable effort has been made to contact me.

I grant permission to Pleasant Valley Christian Camp and its affiliates including program staff and camp staff to provide any needed emergency treatment prior to the registered participant’s admission to a medical facility.

This release is authorized for 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.

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.

My Products

Full Registration$175.00

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 Canteen credit will be donated to the Winter Junior Retreat's selected missionaries: Bruce and Sherry Thacker with As We Go Missions (www.aswegomissions.org). NOTE: We cannot refund unspent Canteen credit. Examples of Canteen prices include: candy, snacks, and drinks: $1 each | toiletries: $2 each | T-shirts: $10-15 each | hoodies: $30-35 each | insulated travel mugs: $25 each | insulated water bottles: $30 each.

Quantity (multiples of $5)

Enter coupon

Total $0.00

Credit Card

Please stay on this page until it shows that your submission has been received. Check your email inbox for a confirmation message. If you do not receive a confirmation email, check your junk/spam mail folder. Please email us at office@pleasantvalleycamp.org or call us at 360-492-3451 if you do not receive a confirmation email.

Please add office@pleasantvalleycamp.org to your email contacts to make sure you don't miss any messages from us.

2025 Junior Retreat Registration

NOTE: We cannot accommodate special dietary preferences.

Credit Card