Registration Options

Paid in Full
This year we are able to offer something we've never had the opportunity to do...... Camp is free. Yes you read that correctly, camp Is 100% free. A generous family has offered to cover the entire expense of camp this year for anyone who would like to go... so if you want to go, just sign up below!

First Time Campers

I am a guest of...

Camper's Name

Camper's Cell Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Camper's Age

Date of Birth

Gender

Grade

School

T-Shirt Size

Father's Name

Father's Phone Number

Mother's Name

Mother's Phone Number

Parent's Business Phone Number

Address

Please attach a head shot of the camper attending. This will help us familiarize ourselves with the campers.

Browse

If you have any questions or concerns, please contact Jason Cox at (828) 230-7528.

Important Need to Know Info

Terms

* What to bring: Bible, notepad, pen, toiletries, flat sheet & sleeping bag, pillow, towels
*What not to bring: alcohol beverages, drugs, tobacco, fireworks, paintball/airsoft guns, iPods, video games, magazines, or clothing with inappropriate messages.
*Christian Conduct: PHBC maintains high standards of conduct and separation. Anyone who brings alcohol, drugs, or tobacco will be sent home. Any non-cooperative students will also be sent home.
*Dress: All dress for the week should be modest, regardless of our activity. We seek to please the Lord with our dress, as well as represent our church in a respectful manner - so of its questionable - don't wear it!! :) "Church clothes" (skirts for girls, and collared shirts/pants for guys) will be required for nightly services. Shorts are fine for daily activities. All shorts/skirts should come to the knee.

I have read and agree to the terms above.

Medical Information

Physician's Name

Physician's Address

Physician's Phone Number

Emergency Contact

Emergency Contact Number

Insurance Company

Policy Number

Group Number

Date of Last Tetanus Shot

Are Other Immunizations Current?

Asthma

If the camper does have asthma... Do they need to keep the inhaler to use as needed?

Diabetes

Kidney Trouble

Heart Trouble

Other

Medications Taken Regularly & Reason for Taking Medication

Allergies

Restricted Diet - Explain

Permission for Treatment, Photo/Video Notice & Release

I am aware that my child's participation in all youth related activities could involve the risk of injury to my child if he/she participates in church sponsored activities. I hereby agree to let my child participate and to hold Pleasant Hill Church harmless from all liability actions, courses of action, debts, claims, or demands, should my child fail to follow the instructions of the supervising adults. My permission is granted for supervising adults to obtain medical and surgical treatment as may be needed in the judgement of the treating physician for my child by a physician chosen by the church chaperone. I also understand that as a participant, my child may be photographed or videotaped during church sponsored activities and these photos/videos may be used in promotional materials and/or the church website. I am signing of my own free will.

I have read and agree to the terms above.

Invite A Friend

We encourage all campers to invite their friends to share this amazing weekend.

Remember first time campers go for FREE!

First Time Campers

Important Need to Know Info

Medical Information

Invite A Friend

Almost done. Where should we send the confirmation?