Winter Registration

Fee: $55.00

Camper Information

Parent/Guardian Information

Reoccurring Conditions

Please check all that apply:

Medications

Allow my child to be given the following medications if necessary:
(Motrin)
(Tylenol)
(Aleve)
(Tums)
(Benadryl)
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.

Signature

I hereby give 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. I also give permission for the camper named to be photographed and/or video recorded for promotional purposes. By filling in the box below, I accept that this will serve as my signature for the electronic document or record.