Piedmont Camp 2025

PIEDMONT CAMP 2025 (July 6-11)

Please complete the following application no later than June 21, 2025.
Piedmont Conference Camp

Sunday July 6 - Friday July 11

Appalachian Advent Christian Campground

190 Maranatha Blvd.

Blowing Rock, NC 28605

Emergency Phone Number: 828-295-3525

blclemons93@gmail.com

Ages 8 - 13

Directors: Brandon & Cassie Clemons

Arrival: Sunday, July 6 between 3 and 5 PM

Departure: Friday, July 11 between 10:30 AM and 12:00 PM

Cost: $225 – Campers do not need money at camp. Camp cost includes all store times and swimming. Please do not send snacks due to campers and staff with severe food allergies. Pre-Register by Saturday, June 21st by submitting the online registration form or mailing the registration form and a check for $25 (registration fee) or the full amount of $225.00 per camper to Brandon Clemons, 608 1/2 W. Concord St. Morganton, NC 28655. Make checks payable to PACC.

SPACE IS LIMITED - FIRST COME, FIRST SERVE. MUST PRE-REGISTER BY JUNE 21

New Policy: Please call ahead if you plan to visit your child during our visitation hours. We will be at the pool on Tuesday of the week so please, no visitors that evening. Parents are welcome to visit after dinner (6:30 - until the end of chapel). When you are asked to leave, you must leave.

Room Assignments: We will make room assignments once applications are received. No camper, unless they are siblings, will share a bed. Most beds are twin, but some are double beds. Please be prepared with sheets for either of those types of beds.

ITEMS TO BRING

Bible
Soap, Shampoo, Personal Items
Towel & Washcloths
Bathing Suit (modest 2-piece or 1 piece, no bare midriffs)
Sunscreen
Footwear must be worn outside at all times - athletic shoes for games
Durable, modest, casual clothing
Old T-shirts to “get dirty” in
Warm & cold weather clothes
Sleeping bag or double sheets

ITEMS TO LEAVE AT HOME

All electronic devices
Tightfiting, suggestive, or revealing clothing
Weapons of any kind
Skateboards or rollerblades
Tobacco products
Matches or lighters
Anything illegal
Anything of high value
Hammocks
Snacks and drinks (we provide those and do not allow them in rooms)
Camper Information
This application is for a...

CamperDC (Developmental Counselor, rising freshmen & sophomores only)
Camper's Name*

First NameLast Name
Birth Date

MonthDayYear
Grade entering in the Fall:*
numbers only
Camper age at time of camp:*
numbers only
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Affiliated Church Name
My camper would like to request to room with...
Parent/Guardian Information
Parent #1 Name*

First NameLast Name
Primary Phone Number*
Secondary Phone Number
E-mail*
example@example.com
Parent #2 Name

First NameLast Name
Primary Phone Number
Secondary Phone Number
E-mail
example@example.com
Emergency Information
Emergency Contact #1 Name*

First NameLast Name
Relationship*
Phone Number*
Emergency Contact #2 Name

First NameLast Name
Relationship
Phone Number
Please list any physical limitations (asthma, diabetes, allergies, etc.) and/or special instructions (allergic to/rare blood type/contact lenses, etc...) If none, put N/A.
List all prescription medications or over the counter medications taken on a regular basis and any brought to camp, including inhalers.
Camper Pick Up

If I, the parent or guardian, am not picking up my child/ren from camp, one of the following has permission to do so:
Name

First NameLast Name
Relationship
Name

First NameLast Name
Relationship
I give the Piedmont A.C. Youth Board permission to photograph my child(ren) in individual and group pictures to use in websites, public brochures, posters, and camp displays.
Damage Contract

Damage to individual rooms will be charged to those using the room. Please help us maintain our facilities by stressing to your camper(s) that he/she should not write or carve names, initials or anything else ANYWHERE on the property.
I understand and agree to the Damage Contract
Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor 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 minor’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 minor surgical treatment, x-ray examination and immunizations for the named camper. 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 in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Piedmont Camp and its affiliates including Directors, Counselors, and Camp Nurse to provide the needed emergency treatment prior to the child’s admission to the medical facility.

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

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 named minor child, in my absence.
Medical Consent
Please list all over the counter medications that your child cannot take or that you prefer them not to take.
If your child will need daily prescription or over the counter medication while at camp, our nurse will follow the schedule you provide. Please provide the name of the medicine, the dosage, the time of day, and any other directions in the space below.
Medical Release & Medical Consent Confirmation

I give permission for my child/camper (above) to receive medication during camp.
I give permission for my child/camper (above) to receive medication during camp.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Piedmont Camp during the selected camp. In exchange for the acceptance of said child’s candidacy by Piedmont Camp, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Piedmont Camp and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Piedmont Camp including Directors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all camp activities.
Confirmation

BY ACKNOWLEDGING BELOW, 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.
Date*

MonthDayYear
Date
I acknowledge that I have given truthful information that would be necessary to release to Piedmont Advent Christian Camp and the affiliated Piedmont A.C. Youth Board for my child to attend Piedmont Camp 2025.
*REMINDER

Please send all checks made out to "PACC" to

Brandon Clemons

608 1/2 W Concord St.

Morganton, NC 28655

Payments cannot be submitted online.

Please be sure to send a $25 deposit upon submitting this form with your camper(s) name.
Should be Empty:

PIEDMONT CAMP 2025 (July 6-11)

Camper Information

Camper Pick Up

Damage Contract

Medical Consent