Summer Camp

PHA SUMMER CAMP

Faith Friends Fun
CAMPER INFORMATION FORM

Child #1
Campers Name

First NameLast Name
Campers Date Of Birth

MonthDayYear
Date
T-Shirt Size
Parent # 1 Name

First NameLast Name
Parent #1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent #1 Email
example@example.com
Parent # 2 Name

First NameLast Name
Parent # 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent # 2 Email
example@example.com
Group
Weeks Camper Attending
Do you have another camper?

Child #2

Please Fill out Completely
Campers Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Camper T-Shirt Size
Age Group
Week Camper is Attending
Do you have a 3rd camper?

Child #3

Please Fill Out Completely
Campers Full Name

First NameLast Name
Campers Date of Birth

MonthDayYear
Date
Campers T-Shirt Size
Age Group
Date Camper is Attending

Emergency and Medical Information

Please provide information we may need in case of an emergency.
Emergency Contact Full Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Camper
Allergies and Medical Information
Does your child have any allergies?
Please List all Allergies
Does your child requie any medication while at camp?
Medication name, dosage, and any instructions

Authorized Pickup

Please list all individuals authorized to pick up your child from camp.
I understand that a valid photo ID is required for anyone picking up my child.
Individuals Authorized to Pick Up Your Child

Please list full name, relationship, and phone number for each authorized person.

Individuals Authorized to Pick Up Your Child

Rows	Full Name	Relationship	Phone Number
Authorized Person 1
Authorized Person 2
Authorized Person 3
Authorized Person 4

Camper Behavior Agreement

To ensure a safe and positive camp experience for all children.
Providence Hill Ranch Camp is a structured, faith-based program. Campers are expected to follow instructions, treat others with kindness and respect, use appropriate language, remain with their assigned group, and follow all safety rules — especially around animals and horses.

Bullying, aggressive behavior, refusal to follow safety rules, or behavior that puts the camper or others at risk may result in immediate parent contact and possible removal from camp at the discretion of camp leadership.

I understand that refunds are not guaranteed if a camper is dismissed due to behavior or safety concerns.
Date

MonthDayYear
Date
Parents Signature

Ranch & Horse Activity Liability Waiver

Please read and acknowledge before completing registration.
Ranch, Premises & Pool Liability Waiver

I understand that Providence Hill Ranch Camp is held on an active ranch property and includes outdoor activities and exposure to ranch environments. Activities may include interaction with farm animals and horses, ranch chores, outdoor games, walking on uneven terrain, and general use of the ranch premises.

I acknowledge that ranch properties contain inherent risks, including but not limited to uneven ground, dirt and gravel surfaces, fencing, gates, tools, equipment, insects, wildlife, weather conditions, and other natural or man-made hazards.

I understand that horses and other animals can behave unpredictably and that interaction with animals involves inherent risks, including the risk of injury. I agree that my child will follow all safety rules and instructions given by camp staff at all times.

I acknowledge that a swimming pool is present on the property. I understand that swimming is not a scheduled camp activity, but I acknowledge the inherent risks associated with the presence of a pool. I understand that camp staff will supervise campers and restrict access to the pool area; however, I accept responsibility for the inherent risks associated with the premises.

I understand that closed-toe shoes are required for all ranch and outdoor activities, and that camp staff may restrict or remove a child from certain activities if safety rules are not followed.

In consideration of my child’s participation, I voluntarily assume all inherent risks associated with ranch activities and the premises, and I release and hold harmless Providence Hill Ranch Camp, its staff, volunteers, property owners, and affiliates from any claims, demands, or causes of action arising from ordinary negligence related to participation in camp activities or presence on the ranch property, except where prohibited by law.
I have read and agree to the Ranch, Premises, and Pool Liability Waiver above.
Date

MonthDayYear
Date
Signature

Camp Tuition & Payment

Your registration is not complete until payment is received.
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PHA SUMMER CAMP

CAMPER INFORMATION FORM

Child #2

Child #3

Emergency and Medical Information

Allergies and Medical Information

Authorized Pickup

Camper Behavior Agreement

Ranch & Horse Activity Liability Waiver

Camp Tuition & Payment

My Products