June 22nd - June 27th

Camp Pitt   1232 Oxford Rd. Chatham, VA. 24531

Price - $260.00

Check-in - Sunday, 4:30pm  --  Check-out - Friday, 11:00am

For more details on what's included in the cost, discounts and deadlines, and volunteer staff, please visit our website at camppitt.org





Carpooling? If someone other than the parent/legal guardian will be checking-in OR checking-out your Camper, please complete this section.

Medical Insurance

Medical / Allergies / Medications

*ALL MEDICATIONS MUST BE IN THEIR ORIGINAL CONTAINER. PRESCRIPTIONS MUST HAVE CAMPERS NAME ON IT. *

Terms and Conditions / Privacy Statement


Program Participation

I, the parent/guardian of the above camper(s), understand that completion of this form with my signature grants permission for the named camper to participate in a Camp Pitt program. I release Camp Pitt staff, faculty, officers, and management from any liability and shall not hold them responsible for any lost, stolen or misplaced personal property. Camp Pitt is permitted to use video, audio, and photographic materials of named camper(s), taken while participating in or attending a camp program, to promote and market Camp Pitt and its ministry.

Beliefs and Practices

I, the parent/guardian of the above camper(s), acknowledge Camp Pitt is a Christian ministry with deeply held Biblical convictions. I understand that Camp Pitt's beliefs provide the foundation for, shape, and animate all programs, policies, and operations. I have had the opportunity to review those beliefs and consent to the camper(s) hearing and learning about Camp Pitt's Christian convictions, and otherwise consent to the camper(s) participation in the Camp Pitt programs consistent therewith. 

Medication Permission and Medical Consent

I, the parent or guardian of the camper(s) named on this form, give my permission to the camp nurse and/or other authorized personnel at Camp Pitt to distribute over-the–counter remedies or medications for minor needs such as: headache, fever, minor pain, minor allergic reactions, upset stomach, minor injuries; and, to dispense prescription and over-the-counter medication designated and provided by the the parent/guardian or family physician. I, having the authority to consent for the minor’s health care, do hereby delegate my authority to consent to said minor’s care (named in this registration) to Camp Pitt. I grant permission for the caregiver to request and authorize any and all examinations, medical treatments, and/ or procedures to or for the benefit of the minor as may be deemed advisable or appropriate by any physician licensed to practice medicine. I understand however that every effort will be made to contact me in case of such emergency and if possible, before any such medical treatment is administered. Camp Pitt provides medical co-insurance for all participants. The family or individual medical policy will be primary. The camp's policy is secondary and will pay eligible costs as determined by the camp's insurance provider to the limit of the policy. I understand I am responsible for any medical cost that may occur on behalf of the camper.

Refund Policy

Registrations are non-refundable. All registrations are 100% transferable to another camper. Parents/legal guardians must request a code from the Camp Pitt office ([email protected]) to transfer a registration to a new camper. Cancellations due to a medical emergency, illness, or family emergency can receive full refunds upon request and approval. 

By e-signing this document you confirm you have read and agreed with the terms, conditions and policies provided in this online registration.

Checkout

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