Bethel Baptist Association

Camper Registration

*Required Information

SUBMIT NO LATER THAN 06/17/2021

Please choose which camp you will be attending *

	Youth Camp (Grade 7-12)
	Childrens Camp (Grade 3-6)
	Kids Day Camp (Grade K-2)

Name *

Date of Birth mm/dd/yyyy

Gender

	Male
	Female

Grade Completed *

Sponsoring Church / Association *

You must pay your sponsoring church to be completely registered. Make checks payable to Bethel Baptist Association.

T-Shirt Size *

Parents / Guardians *

Email Address *

Home Phone

() -

Work Phone

() -

Cell Phone

() -

Street Address

City

State

Zip

Message to Camp Director

Important messages that may also include a request for cabin assignments.

Camp Policy Regarding Head Lice

A head check will be completed for all campers during camp check-in. If any nits or lice are found, the camper will be sent home with a refund of their registration fee, without the option of returning to camp. No exceptions will be made.

Dietary Needs / Food Allergies

IMPORTANT: Please list all food allergies, dietary needs and any information we may need.

Message to Camp Medical Person

IMPORTANT: List special allergies, medical problems and any medicine instructions.

Note: All medicine MUST be in original container(s) with complete instructions and MUST be turned into Camp Nurse during registration/check-in. Only send the exact doses necessary for the entire camp duration. DO NOT send extra medicine. DO NOT send Tylenol, or Ibuprofen as these are provided.

If needed may Tylenol be given by the Camp Nurse?

If needed may Ibuprofen be given by the Camp Nurse?

Emergency Contact*

Name
Relationship
() - Phone Number

Alternate Emergency Contact*

Name
Relationship
() - Phone Number

Physicians Name

Insurance Company

Medicine #1

Indicate Name, Dosage (mg or ml), How Many/How Much, Times to be Taken.

Medicine #2

Indicate Name, Dosage (mg or ml), How Many/How Much, Times to be Taken.

Medicine #3

Indicate Name, Dosage (mg or ml), How Many/How Much, Times to be Taken.

Medicine #4

Indicate Name, Dosage (mg or ml), How Many/How Much, Times to be Taken.

Church Member?

	Yes
	No

Church Name

Christian?

	Yes
	No

Baptized?

	Yes
	No

Age

Indicate Age at Time of Camp.

Camp Guidelines Agreement *

Mark the checkbox only if you have read and agree to the Camp Information and Camp Guidelines.

1. Camp Information
2. Camp Guidelines

I have read and agree with the Camp Information and Camp Guidelines.

Parent / Guardian Signature *

I (We), the undersigned parent(s) or guardian(s) of the above mentioned minor child, do hereby give consent for any emergency care deemed necessary by Bethel Baptist Association Camp leaders and/or the medical facility(ies) to which he/she is taken. I (We) further agree to release Bethel Baptist Association and its representative from liability for any injury or mishap which may occur at camp, including accident which may occur during transportation to or from camp. I (We) further agree to give consent to post camp pictures of my (our) child(ren) to the Bethel Baptist Association Facebook page, the Bethel Baptist Association website and any related publications, sites or pages.

Sign by indicating your name or email address.