Coupon Code: EarlyBird
Use this coupon code to get a discount

Early Bird: $420 from January to February 9, 2025.
Regular: $450 from February 11 to April 30, 2025.
Late: $470 from May 1 to May 19, 2025.

Camper Information

Registration Options

Camp Registration ($470.00)
The camp fee includes meals, lodging, and camp activities. Some classes have an additional fee, which may be paid during check-in. Fees must be paid when applying to camp. (The priority for class selections will depend on the date the camp fee is paid)
Hartland Staff Campers ($470.00)
If you work for Hartland, please request a special coupon.

Camper Name

Date of Birth

Gender

Male
Female

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.

Mailing Address (Street)

T-Shirt Size

Hoodie Size

Important Questions

What grade will you be entering this fall? Field

What school do you attend?

What church do you attend?

Are you a baptized member?

Check the reasons you are coming to camp:

Camper Agreement

I have carefully read the camp information brochure. As the applicant, I agree to abide by all the camp codes and rules and to cooperate fully with the counselors and other staff. I understand that if I fail to do so, I will be sent home at my expense and will forfeit all camp fees.

Note: This is a digital signature. The following may be filled out by the applicant’s parent/guardian.

Camper's Signature

Date

First Parent / Guardian

Relation to Camper

Parent's Email

Cell Phone / Work

Home Phone

Second Parent / Guardian

This section is optional.

Name

Relation to Camper

Work Phone Number

Home Phone Number

Who has the custody of the applicant?

If parent/guardian cannot be reached, contact:

Name

Work Phone Number

Home Phone Number

The person(s) authorized to pick up camper after camp:

Name

Phone Number

Allergies:
IMPORTANT: Please notify the camp if camper has been exposed to any communicable disease during the three weeks prior to camp.

Medication:

List all medications you are allergic to.

Plants:

List all plants you are allergic to.

Food:

List all food you are allergic to.

Insects:

List all insects you are allergic to.

Type of reaction

List all type of reaction to your chosen allergies.

Treatment

List all treatments to your chosen allergies.

Medical Insurance Carrier and Policy Number:

Please select from 1 to 3 in order of your interest in the following class categories: Outreach, Recreational, and Life Skills.

*To see what the class is about, click on one of the 3 options under each class

OUTREACH CLASSES

Bible Work

Child Evangelism:

Emotional Health:

Choir:

Orchestra:

On Fire for Mission:

RECREATION CLASSES

BAKING:

PAINTING:

FITNESS:

CANOEING:

AGRICULTURE:

CROCHET:

DRAWING:

PHOTOGRAPHY:

SCIENCE EXPERIMENTS:

LIFE SKILLS CLASSES

AUTO MECHANICS:

KITCHEN CREATIONS:

HOMILETICS:

MEDICAL MISSIONARY TRAINING:

MIDWIFERY:

MISSIONARY PILOT GROUND SCHOOL:

WILDERNESS SURVIVAL:

WOODWORKING:

MISSIONAL ENTREPRENEURSHIP:

Airport Shuttle

Airport Pick-Up/Drop-off

Parent / Guardian Authorization

As parent or legal guardian of the applicant, I am in favor of the applicant attending camp and participating in all activities unless otherwise specified in writing. I hereby release the camp and its personnel from liability in case of accident or illness, and I understand I am responsible for any charges incurred in treatment of my child's illness. In case of emergency, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give permission to the physician selected by the camp directors to administer natural remedies as deemed appropriate and/or to hospitalize and administer anesthesia and medications as required, or perform surgery on my child. I also give permission for Piedmont Bible Camp to use pictures/videos/recordings taken of my child during camp for promotional and/or illustrative purposes.

Signature of Parent / Guardian

Date

🌟 Ignite the Flame for Eternity 🌟

At Piedmont Bible Camp, we’re on a mission to kindle a spark in the hearts of young people—a spark that deepens their relationship with Jesus and ignites a passion for sharing His love.

But we can’t do it alone. Your support can help us make a difference.

💙 Donate today to help shape the next generation of young people on fire for God. Every contribution fuels a future filled with hope, faith, and purpose.

📖 Be the spark. Donate now.

Paste your coupon code here to get your discount

Total

$0.00

JUNE 8—15, 2025 PIEDMONT BIBLE CAMP IS FOR YOUTH AGES 12 TO 17.

Camper Information

Important Questions

Camper Agreement

PARENT / GUARDIAN INFORMATION

Medical Information

CLASS SELECTION

Airport Shuttle

Parent / Guardian Authorization