Register | Pinecroft Christian

Registration

To register please fill out the appropriate information below, NOTE: Registration is required for each individual attending

First Name

Last Name

Phone Number

Address

Birthday

Age

Grade This Fall

Gender

Cabin Mate Request

T-Shirt Size

Please explain any medical conditions including: allergies, special medications, life-threatening allergies or physical reasons for not participating in sports.

Health Insurance: include company name and policy#

Any Dietary Restrictions or Food Allergies?

Family Physician: Name and Phone#

Emergency Contact Name

Emergency Contact Phone#

Emergency Contact Relationship to Camper

Camp Rules and Dress Code

CAMP AGREEMENT: (Parent or Guardian and camper must read and sign) “I have read Pinecroft’s Camp Rules and Dress Code and I will cheerfully comply with all camp rules, obey camp leaders, and participate in all activities I am physically able to. I understand that any violation of rules or policies may result in dismissal from camp without refund.”

MEDIA RELEASE: Part of the camp experience at Pinecroft Christian Camp is our daily photo and video slideshows. It is from these photos and videos that we get the images to use for our promotional materials and camp brochures for Pinecroft Christian Camp.

MEDICAL: I give permission for the camp nurse to dispense over the counter medications as needed for the care of my child according to manufacturers dosing instructions. (E.g.: Tylenol, Ibuprofen, Benadryl, Cough syrup, Pepto-Bismol, Midol, etc.) Prescription medication must be in their original prescription containers for the nurse to disperse to your child.

HEALTH AND ACCIDENT INSURANCE: Pinecroft carries Health & Accident insurance for your camp week. BUT, Pinecroft insurance is secondary to any family health/accident insurance. In other words, if you have family insurance and your child requires treatment at a local hospital or hospitalization, your insurance would pay first. Pinecroft insurance would cover what your insurance does not. In the event that there is no family insurance, Pinecroft insurance covers any medical cost resulting from accidental injury sustained while involved in any Pinecroft activities.

RELEASE AND ARBITRATION AGREEMENT: IN CONSIDERATION OF the use of the camp facilities owned/operated by SPOKANE SLAVIC BAPTIST CHURCH, PEND OREILLE BIBLE CAMP, and PINECROFT CHRISTIAN CAMP by myself or one or more of my children or wards, I, for myself, or the minor child named below, forever waive, release and discharge PINECROFT CHRISTIAN CAMP or PEND OREILLE BIBLE CAMP and its parent corporation, SPOKANE SLAVIC BAPTIST CHURCH from any/all injuries, claims, disputes, liabilities, or actions resulting from the use of the camp, regardless of location, from July 13, 2025 through and including July 25, 2025. I attest and verify that I have full knowledge of the risks and dangers involved; that I assume such risks, and that I will assume and pay my own medical expenses, in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. Any controversy arising out of, connected to, or relating to this Release and Agreement between me and the above named parties or on behalf of the minor child named below, or the breach thereof, including, but not limited to any claims of violations of Federal and/or State law, as well as any common law claims shall be settled by arbitration through the Christian Consolation Services: and in accordance with this paragraph a judgement based upon the arbitrator’s award may be entered in any court having jurisdiction thereof in accordance with the provisions of R.C.W. 7.04. This agreement shall be construed and interpreted under the laws of the State of Washington.

I HAVE READ THIS RELEASE, RULES AND ARBITRATION AGREEMENT CAREFULLY, AND UNDERSTAND IT

Camper Signature

Date required

Parent/Guardian Signature

Date required

Thank you for registering!