PCAFI C.A.N. CAMP Registration Form

Student (Camper)Adult (Chaperone)

Student (Camper)Chaperone

Student (Camper) Information

Student First NameStudent Last Name

Student Date of Birth

Upload Student Photo

Parent / Guardian Information (For Student Registration Only)

Parent First NameParent Last Name

Parent Email

example@example.com

Parent Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Chaperone Name

First NameLast Name

Chaperone Email

example@example.com

Chaperone Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Church Name*

Pastor's Name*

Council*

Emergency Contacts

Primary Emergency Contact First NamePrimary Emergency Contact Last Name

Primary Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contacts

Secondary Emergency Contact First NameSecondary Emergency Contact Last Name

Secondary Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

YesNo

If yes, please provide details.

Medications

YesNo

If yes, please provide details.

Food Allergies

YesNo

If yes, please share details below.

Special Needs/Physical Limitations

Student Profile & Engagement - What extracurricular activities is your student involved in?

BeginnerSome familiarityVery familiar

I, the undersigned parent or legal guardian, acknowledge that participation in the Pentecostal Churches of the Apostolic Faith International (PCAFI) Summer Camp may involve activities that include, but are not limited to: outdoor games, sports, field trips, physical activities, transportation, water-related activities (if applicable), and indoor recreational activities. I understand that these activities may carry certain inherent risks of injury or harm. I voluntarily assume all risks associated with my child’s participation.I, the parent or legal guardian of the above-named participant, hereby give permission for my child to participate in PCAFI CAN Camp and all related activities. I understand that participation in camp activities involves inherent risks, including but not limited to physical activity, transportation, and group events.I certify that my child is physically able to participate and that I have disclosed all relevant medical information.

I release, waive, and hold harmless PCAFI, CAN Camp, its directors, staff, volunteers, partners, and affiliates from any and all liability, claims, demands, or causes of action that may arise from my child’s participation in camp activities, except in cases of gross negligence.In the event of a medical emergency, I authorize PCAFI staff or representatives to secure medical treatment for my child. I assume full responsibility for any medical expenses incurred as a result of such treatment.I hereby grant permission to PCAFI CAN Camp to photograph, video record, or otherwise capture my child’s likeness during camp activities. I understand that these images and recordings may be used for promotional, educational, and marketing purposes, including but not limited to social media, websites, printed materials, and presentations. I release PCAFI and CAN Camp from any expectation of compensation or ownership rights related to these materials.

I, the undersigned parent, agrees to complete Parent Preparation Training Session prior to camp.The student agrees to follow all rules of conduct set forth by PCAFI Camp leadership.

I certify that I am the parent or legal guardian of the above-named child. I have read and fully understand this Release of Liability Agreement. I agree that this release is binding to the fullest extent permitted by law.

Yes (Required)

Full Camp Registration ($250)

Registration Amount

Registration*

Deposit ($100)

$100.00

Full Camp Registration ($250)

$250.00

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

ACH Bank Transfer

PCAFI CAN Camp Registration Form

Agreements & Permissions

Chaperone Only

Payment Information

Payment Methods