Summer Camp Registration* indicates required fieldsStep 1 of 333%Parent DetailsName* First Last Email* Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Camper DetailsName* First Last Birth Date* MM slash DD slash YYYY Gender*MaleFemaleRising Grade*Kindergarten1st2nd3rd4th5th6th7th8thT-Shirt Size*Youth - Extra SmallYouth - SmallYouth - MediumYouth - LargeAdult - SmallAdult - MediumAdult - LargeAdult - Extra LargeSchool*This field is hidden when viewing the formWeek 1 Junior Lion’s Summer Camp—June 2-5 Basketball Shooting Camp—June 2-5 Flag Football Camp—June 2-5 PCA Lion’s Cheer Camp—June 2-5 Soccer Skills Camp—June 2-5 Quarterback & Receiver Day Camp—June 7This field is hidden when viewing the formWeek 2 PCA Volleyball Camp—June 9-12 PCA Baseball Camp—June 9-12 Princess Dance Camp—June 9-12 Bot Builders: A Wild Robot Adventure—June 9-13 Football Skills Camp—June 9-12 Grammar School Theatre Camp—June 9-13 Offensive/Defensive Lineman Day Camp—June 14 PCA Middle School Home Cheer Camp—June 13-14Week 3 Summer Adventure Camp—June 16-19 PCA Softball Camp—June 16-19 Glow Week STEM Camp—June 16-19Week 4 Basketball MEGA Camp—July 7-10Tennis Camp Full Camp - June 2-20 Week 1 - June 2-6 Week 2 - June 9-13 Week 3 - June 16-20Medical Release:* I agree to the medical release.In consideration of the opportunity provided by Providence Christian Academy (PCA) and the PCA Summer Camps, I do hereby voluntarily and with full understanding forever discharge, waive, release and hold harmless PCA from any claim which may arise from any injury or illness sustained by my camper while participating in any summer camp activity, event, contest, etc. including any injury or illness resulting from the negligence or tortuous activity of PCA, its officers, directors, employees, agents or volunteers. A parent/guardian’s signature below grants PCA staff or its agents full approval to have the participant receive voluntary and/or professional medical treatment in the case of an injury or an accident. I have read the above Informed Liability Release. I understand its contents and all the implications and voluntarily agree to be bound by said release, in whole and by each of its parts.Cancellation Policy:* I agree to the PCA Camp Cancellation PolicyAll camp withdrawal requests must be submitted in writing to camps@providencechristian.com at least 14 days prior to the camp’s start date. Full Refund Eligibility Withdrawal requests received 14 or more days before the camp start date are eligible for a full refund. 50% Refund Eligibility Withdrawal requests received 1 to 13 days before the camp start date are eligible for a 50% refund. No Refund Eligibility Cancellations made on or after the first day of camp are not eligible for a refund. Early Departure If a camper leaves camp early for any reason, no refund will be issued. Non-Attendance Failure to attend or participate in the camp does not entitle the participant to a refund. *Exceptions to this policy may be considered on a case-by-case basis in the event of a documented emergency. **We understand that summer plans can change. Please let us know as early as possible if your child can no longer attend camp.Photo Consent* I agree to the photo release.I agree to allow PCA to photograph, videotape or make other images of my or my child's participation in tahe course. Further, I understand the pictures may be used in advertising, display, education, audio/visual or other use to promote PCA without compensation. PCA takes no responsibility for pictures taken by other participants.