2025 ADVENTURE SUMMER CAMP REGISTRATION Form

* Required Information

First Name *

Last Name *

Address *

Phone Number *

Grade in Fall *

School Attend *

Date of Birth *

Gender *

Male

Female

T-Shirt Size *

Adult Size

Youth Size

Medication Administration *

Asthma *

YES

Special Needs *

YES

Allergies *

Nursing Services *

YES

TSS Services *

YES

Before / After Care Needed *

YES

If so, days/hours needed

Parent/Guardian Name

Phone

Email

Parent/Guardian Name

Phone

Email

Address

PRECIOUS MOMENTS CHRISTIAN ACADEMY REGISTRATION FORM, RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT IN CONSIDERATION of being permitted to utilize the facilities, services and programs of the PMCA(or for my children to so participate) for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the PMCA, the undersigned, for himself or herself and such participating children and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that he or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into the PMCA for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation by the undersigned and such children.

In further consideration of being permitted to enter PMCA for any purpose including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with the PMCA, the undersigned hereby agrees to the following:
   1. THE UNDERSIGNED ON HIS OR HER BEHALF AND BEHALF OF SUCH CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE the PMCA and all branches thereof, its directors, officers, employees, and agents (hereinafter referred to as "releases") from all liability to the undersigned or such children and all his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned or such children whether caused by the negligence of the releases or otherwise while the undersigned or such children is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with PMCA.

  2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releases and each of them from any, loss, liability, damage or cost they may incur due to the presence of the undersigned or such children in, upon, or about the PMCA premises or in any way serving or using any facilities or equipment of the PMCA or participating in any program affiliated with PMCA whether caused by the negligence of the releases or otherwise.

  3. 'I'HE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE to the undersigned or such children due to negligence of releases or otherwise while in, about or upon the premises of the PMCA and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with PMCA.

The undersigned gives permission to PMCA for this registrant to appear in photographs, videotapes, or other media, etc., associated with PMCA programs. PARENTS: Our staff is trained in child abuse prevention and all staff sign a code of conduct. Please report any suspicious activity immediately. The undersigned agrees to abide by the Program Refund Policy as stated in the PMCA policy handbook. There are no refunds for summer camp.

PRECIOUS MOMENTS CHRISTIAN ACADEMY is founded on Christian principles and values and prohibits inappropriate behavior, conduct, and materials. This includes, but is not limited to, profanity or abusive language, attire, smoking, use of alcohol or drugs, weapons, fireworks, pornography, the removal or misuse of PMCA property, or criminal conduct of any type. Such inappropriate behavior, conduct, or materials is unacceptable. PMCA consequently retains the right to deny program participation to its applicants at its sole discretion. Pets are not allowed at PMCA facilities or off-site program locations. All program participants, guests, and members who are minors are not allowed to leave PMCA property unless accompanied by a relative or pre-authorized guardian. Some programs require personal equipment not supplied by the PMCA. Further, the undersigned will at all times display the PMCA values of Honesty, Respect, Caring, and Responsibility and encourage the efforts of all players, coaches, spectators and referees in a positive manner. The undersigned understands PMCA mission in offering this program: to build strong kids, strong families, and strong communities.