Summer Registration

Week of Camp

Camper Information

Parent/Guardian Information

Confirmation receipt will be sent to Parent/Guardian Email Address.

Reoccurring Conditions

Please check all that apply:


These are the medications we will have on hand for use as needed. You do not need to bring a supply of these items for your child, unless your child uses them on a daily basis; we supply these for “as needed” use.
Please remove (uncheck) any items you do NOT want your child to receive.
“Medication” is any substance a person takes to maintain or improve their health, including vitamins and natural remedies. You must bring all prescription items in original pharmacy container with label showing camper's name and instructions. Please bring over-the-counter items in original packaging.

Authorization for Care

Medical Release:
This health history is correct and accurately reflects the health status of the camper to whom it pertains. The camper has permission to participate in all camp activities, except as noted by me above. I understand that, in the event of an emergency, every attempt will be made to contact me, so that I may choose to consent for health care for my child, and that due to the location of Camp Bethany, there may be up to 30 minutes before major emergency medical care can be provided. In the event that I am unable to be contacted in the time allotted, I give permission to the health care professional selected by the camp to order/authorize x-rays, routine tests, and treatment related to the health of my child for both routine health care and in emergency situations. This is to include permission to hospitalize or secure other proper treatment, including anesthesia and surgery if deemed necessary by the camp's representative and the treating physician. I give permission for a photocopy of this form to be used in place of an original.

Media Release
I hereby grant permission to Camp Bethany, its Directors, and its employees the irrevocable and unrestricted right to produce photographs, videos, and interview statements taken of my child while at Camp Bethany for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium by Camp Bethany. I hereby release Camp Bethany and its legal representatives from liability for any violation or claims relating to said images or videos. Furthermore, I understand that once my child's image, or video is published on a website, it can be downloaded by any computer user. Personal information, such as my child's name, address or telephone number will never be published. If my child's name is used with a photograph, video, or interview statement, it will be in the form of a first name and last initial. For example, camper Jane Doe may be listed as “Jane D.” Lastly, I waive my right, and my child's rights to any and all compensation stemming from the use of these materials. To request an exemption from this, please contact our Camp Director for assistance.

By filling in the box below, I certify that I accept the above statements and acknowledge that this will serve as my signature for the electronic document or record.

A non-refundable 25% fee is required to reserve your registration.
To accomodate some churches paying partial amounts for their students you may opt to pay the required deposit now or pay half of your fee and pay the rest at registration, or you may pay the full registration now.