PVCC Camp Registration

PVCC Camp Registration

Summer 2026
Campers and volunteers MUST be registered and paid for on SEPARATE forms. Please fill out the following information for either a camper or a volunteer.
CamperStudent VolunteerAdult Volunteer
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CAMPER INFORMATION
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STUDENT VOLUNTEER
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ADULT VOLUNTEER
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MaleFemale
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
K1st2nd3rd4th5th6th7th8th9th10th11th12th2026 Graduate
Church Attending With:*
If church is not listed, please choose Not Listed from list above.
Church Name Not Listed above
Group Leaders Name:*

First NameLast Name
High School Camp - May 31 - June 5Middle School Camp - June 7-12Junior Camp - June 14-18First Chance Camp - June 19-20Day Camp - June 20Kid's Camp - June 22-25Hybrid Camp - June 28 - July 1
YSYMYLASAMALAXLAXXLAXXXL
YesNo
NewsletterChurchInvited by a friendOlder sibling has attended
Who invited you?
----------------------------------------------------------------------------------------CAMP PERMISSIONS/ACKNOWLEDGEMENTS
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.*

Grant Risk PermissionDeny
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.*

Grant medical permissionDeny
Agree with camp values and behavioral expectations
Grant photo/video permissionDeny
YesNo
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PARENT/GUARDIAN INFORMATION
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
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MEDICAL INSURANCE INFORMATION
YesNo
Health Insurance Company
Health Insurance Policy Number
YesNo
Please list all allergies and the type of reaction they cause:
YesNo
YesNo
Please list any food restrictions:
YesNo
IMPORTANT: All medications must be in the original packaging (daily sorters/pill keepers are NOT permitted). Please only send enough medication for the week of camp.
List medications and when they must be taken (example: At Breakfast, At Lunch, Before Bed, As Needed):
YesNo
IMPORTANT: If your child has been diagnosed with asthma by a physician and has medication including tablets, nebulizers, or inhalers, they MUST bring such treatment with them to camp or they will not be allowed to stay at camp!
YesNo
Please explain the health history noted above:
NONETylenolIbuprofenCalamine LotionTumsBenadrylTussin Cough SyrupNeosporinHydrocortisone CreamAlovera
Please upload a photo of the front of your health insurance card:

Cancelof
Please upload a photo of the back of your health insurance card:

Cancelof
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EMERGENCY CONTACT

In case of emergency please contact the following person if the Parent/Guardian listed above is unavailable.
Emergency Contact Name*

First NameLast Name
Emergency Contact Relation to the Camper*
Emergency Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
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ADDITIONAL NON-CAMPER CHILDREN OF ADULT VOLUNTEERS

The intent of this section is to sign up toddlers and infants that are still reliant on the Adult Volunteer on this form for care. Older kids should be signed up as campers on a separate form if they wish to attend the age appropriate camp. Kids in this Non-Camper section will NOT be allowed to participate in camp activities as they are not being charged the full price attendance.
How many additional kids will be attending with you that are NOT campers?
Non-Camper 1

First NameLast Name
Age
MaleFemale
Non-Camper 2

First NameLast Name
Age
MaleFemale
Non-Camper 3

First NameLast Name
Age
MaleFemale
Non-Camper 4

First NameLast Name
Age
MaleFemale
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AUTHORIZATION/CONFIRMATION

I affirm that the information above is true to the best of my knowledge.
Signature*

Clear
Date

MonthDayYear
Date
COST CALCULATION SECTION - FOR DEVELOPMENT ONLY NOT SHOWN ON FORM
Junior Camp - Camper
High School Camp
Hybrid
Kids
First Timer's
Day
Middle School
Non-Camper Kid Cost
Basic Cost Form Calc
Church discount
Early Junior Discount
Early High Middle Discount
Early Hybrid Discount
Early First Timer Discount
Early Kids Discount
Early Day Discount
Early Discount Calc
Standard Deduction - always applies even after early bird to get us to base price
Church payment
Fixed Rate
Churches that will play a flat rate no matter when registered

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CAMP CONFIRMATION

Please confirm your basic selections below as well as the expected cost. If you need to fix anything, please choose the Back button below.

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General Information
- Name: {name}
- Address: {address}
- Email:{email}{parentguardianEmail}
- Phone:{phoneNumber}{parentguardianPhone}
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Camp Information
- Role: {iAm}
- Camp Attending: {pleaseChoose}
- Leaders Name: {groupLeaders}
- Church Attending With: {churchAttending13} {churchName}
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Cost = ${totalCost}

Any discounts will be reflected once Discount Code is entered below if applicable

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Discount Code
Total Cost
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Registration Payment

USDFees for the selection you've made on this form.

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

Should be Empty: