Clone of PVCC Summer Camp 2025 Registration

Prairie View Christian Camp Women's Retreat 2026 Registration

Step 1: Complete this online form. EARLY BIRD REGISTRATION DEADLINE IS September 11, 2026

Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Format: (000) 000-0000.
Church Attending with:

Recreation Options

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, High School and older 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 signing this form accept the risk and choose 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.
Medical Treatment Permissions

To the best of my knowledge, I am 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 my health 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.
Camp Content and Behavior Agreement
I also give my permission for any appropriate photographs/videos to be used for future Prairie View Christian Camp promotional purposes.
The Zip Line Weight Limit is 250 lbs. The participant's weight is below 250 lbs.

Emergency Contact Name

First NameLast Name
Emergency Contact Email Address:
example@example.com
Emergency Contact Phone Number:
Format: (000) 000-0000.

Date of Birth

MonthDayYear
Date
Does the attendee have any allergies?
List all allergies and the type of reaction they cause
Does the camper have any special food restrictions?
Please list any special food restrictions
Does the attendee have any other significant health history (heart condition, diabetes, any injury) or does the attendee have any restrictions/medical conditions that we should be aware of?
If Yes, please explain

By signing this form I affirm my answers to the statements and questions as answered above. If not signed, the attendee will not be allowed to participate in a camp session.

I have read and understand the statements in this release form. I understand that should a health problem arise, I will be notified but if I cannot be reached by telephone I consent to emergency medical treatment, which may include surgery as deemed necessary by competent medical personnel. I also consent to the release of information for insurance purposes.
Participant Signature
Date of Signature

MonthDayYear
Date
Looks like you haven't picked a camp yet. Please go back to the Camp Fees section and select which camp you will be attending, then you may submit the form.

My Products - Please only one attendance option.

Full Weekend - 2 Nights, 5 meals

September 25-27, 26

$130.00

Friday Night & Saturday - 1 Night, 4 meals

September 25 & 26, 26

$85.00

Saturday Only - 3 meals

Saturday Only - Breakfast, Lunch & Dinner.

$60.00

I would like a Retreat T-Shirt

Fantastic! Join us for the Saturday Afternoon craft to create your shirt. Please choose a shirt size from the drop down list.

Free
Item subtotal:

Challenge Tower - Zip line, Rock Climbing, Rappel

Saturday Afternoon

Free

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Prairie View Christian Camp Women's Retreat 2026 Registration

My Products - Please only one attendance option.