Kids Camp 2018

Bethel Kids Camp 2018

Camper Name
Birth Date
Grade Completed in School
Child's T-Shirt Size
Last Tetanus Shot
Primary Doctor
Doctor's Phone
Does Your Child Have Health Insurance?
Insurance Company
Insurance Policy Holder Name
Policy Number
Group Number
Medical Conditions / Physical Limitations

Parent Information

Parent/Guardian 1
Relationship to Child
Cell Phone
Parent/Guardian 2
Relationship to Child
Cell Phone
Emergency Contact if Parents Cannot be Reached
Phone Number

Parent/Guardian Release

As parent/guardian of the child registered, I give my permission for the subject of this release to be involved in the overall activities of Bethel Kids Camp.  I understand all reasonable safety precautions will be taken at all times by Bethel Church and its agents (leaders, employees, staff, and/or volunteers) during Bethel Kids Camp, but I also understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold Bethel Church or its agents liable for damages, losses, diseases and/or injuries incurred by the subject of this release during Bethel Kids Camp.

In the event of an emergency affecting the health or welfare of the subject of this release, I give my permission to the agents of Bethel Church to administer first aid and/or arrange transportation to the nearest doctor or hospital for further medical attention. I understand that I will be responsible for any medical expenses deemed necessary for the health or welfare of the subject of this release.

I give my permission for the subject of this release to be driven in vehicles by the agents of Bethel Church. If the subject of the release has to return home early because of disciplinary violations, it will be at my expense. 

Parent/Guardian Signature

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Cost is $130. A $25 deposit is due by July 1st, with full payment due by July 29th. A $10 late fee will be added for deposits after July 1st.
Amount Paid
Method of Payment