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Registration Form for Children’s Camp "PEARL" - August 2-7, 2026

PEARL is a summer camp for boys and girls ages 7 to 14.  Camp Pearl is held mainly in Russian language. To go to the camp, the child must be fluent in Russian. This is necessary to know what is happening, to participate in the camp program, and for the safety of children.

Летний лагерь «ЖЕМЧУЖИНА» — это увлекательный отдых для мальчиков и девочек в возрасте от 7 до 14 лет.
Наш лагерь проводится преимущественно на русском языке, что создаёт атмосферу дружбы, общения и культурного единства.

Чтобы ребёнок мог полноценно участвовать в жизни лагеря, понимать задания, игры и программу, важно, чтобы он более-менее владел русским языком. Это также необходимо для обеспечения комфорта и безопасности всех участников.

Присоединяйтесь к нашему летнему лагерю и подарите своему ребёнку незабываемые впечатления!

Вопросы? Пишите: CampPearlDMV@gmail.com

Camp cost:

- Regular registration (Before May 31): $325
- Late registration (After June 1st if space available): $355

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Email *
Camper's First Name:
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Camper's Last Name:
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Date of Birth:
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Grade Completed by June: 
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Gender:
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Proficiency in Russian language:  
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Street Address: *
City: *
State: *
Zip Code: *

How many times has this child been to Camp Pearl

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If it’s a first time, how did you find about Camp Pearl: 
Camper's T-shirt size: 
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Name of Father/Guardian:  *
Telephone: *
E-mail: *
Name of Mother/Guardian: 
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Telephone: *
Email: *
Other Contact Person: 
Telephone:

CHRONIC HEALTH CONCERNS OR DISEASES: Describe your camper’s chronic illness or disease and how you take care of it at home:

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ALLERGIES: Please describe what this camper is allergic to; describe the reaction; and what is done to manage the reaction:
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MEDICATIONS: Please inform us of any medications that your child will need in camp, at what time(s) they are to be given, what dosage, and any other important Information:

MEDICAL INSURANCE: Is the camper covered by medical insurance?

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Medical Insurance Company: 
Medical Insurance Policy #: 

Parents/guardians are financially responsible for health care given by an out of camp provider. Insurance concerns can only be managed by parents/guardians and their insurance company. You may want to notify your insurance to determine if your insurance will work while your child is in our program and/or what you need to do should your child need healthcare.   Our healthcare provider will make every effort to contact you by phone if your child has need for out-of-camp healthcare. Although it is determined on a case-by-case basis, we generally do not contact you if your child is seen by the nurse or healthcare provider for routine problems (e.g. skinned knees, sore throat) that do not require a physician referral. Please describe below if you want us to follow a practice different from what is described.

Please Initial here:

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Registration is incomplete until the payment has been received by Camp Pearl.

Please send check or money order to: New Life, 46611 Jefferson Dr., Sterling, VA 20165

- Early registration (Before March 1, 2026): $295
- Regular registration (Before May 31): $325
- Late registration (After June 1st if space available): $355

Refund Policy: A $30 administrative fee will be subtracted from all refunds. The remaining amount will be refunded if the request is made at least ten (10) days prior to the start of camp.

Please Initial here:
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Cell service at the children’s camp is not always stable, so for easier communication we kindly ask all parents to install the Telegram app on their phones.
Through Telegram, we will be able to quickly share updates and keep you informed about camp activities.

Please confirm whether you already have Telegram installed.

Thank you for your understanding and cooperation!

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WAIVER OF CLAIM: I acknowledge that I have been fully informed as to the nature of the activity and the provisions for my child’s involvement and consent to my child’s participation in Camp Pearl activities.  In signing this document, I hereby certify that the above information is correct and give permission for my son or daughter to be transported for approved out-of-camp activities; for the use of video/photographs including my son or daughter to be used in camp publicity; and for the release of medical records in the case of illness. In the event I cannot be reached, I hereby give permission to the physician selected by Camp Pearl staff to obtain proper medical diagnosis, hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery for my child as named above. In consideration of permission granted the herein named individuals to participate in camping activities, we hereby covenant with Camp Pearl that we will never, individually, or as legal guardians of said individuals, institute any action at law or in equity for any personal injuries, or injuries to property, real or personal, caused by, or arising out of, camping and other related activities sponsored by Camp Pearl, its successors, and legal representatives. 

Please sign your name here and click SUBMIT below:

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A copy of your responses will be emailed to the address you provided.
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