Winter Registration

Retreat Information

Camper Information

Parent/Guardian Information

Reoccurring Conditions

Please check all that apply:


Allow my child to be given the following medications if necessary:
All medication must be given to the camp staff upon arrival. All medications should be kept in the original labeled container with the medication name, dosage, and directions clearly indicated on the container. Please use the following spaces to list any health related issues including specific allergies, food allergies, relevant surgeries, physical limitations, or other serious illnesses along with any special treatments or concerns. Please be specific.


I hereby grant permission for emergency medical treatment, including hospitalization, injections, anesthesia, or surgery to the camper named above if such is deemed necessary while attending Camp Bethany. I understand that in the case of emergency, every effort will be made to contact me, but given the situation that I cannot be reached Camp Bethany has permission to act on my behalf.

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, 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.