T-Shirt Size:


    If your church is providing scholarship funds, please list the amount:

    Parent/Guardian Info:

    Parental Contract: I give the camp full authority in dealing with health and discipline problems. Furthermore, should it be necessary for the camper to return home, we (I) assume all transportation cost. I understand that photos of campers may be published on the camp website or camp literature.

    Camper Contract: I have read and understand Bethany Bible Camp Regulations. I agree to do my part to follow them. I further understand that anyone disregarding camp regulations may be sent home at his/her expense.

    Please make checks payable to Bethany Bible Camp. Mail registration/medical form & fee to:
    Bethany Bible Camp, PO Box 562, Bemidji, MN 56619
    Registrar Phone: (218) 289-9211 Camp Phone: (218) 751-6094

    Medical Certificate and Release Form

    Emergency contact info:

    Health Insurance info:

    Family Physician info:

    Health History - Check all medical/food allergies, chronic conditions, or medical problems that apply:

    Other Food or drug allergies

    Other conditions:

    Activity Limitations:

    Medications the camper is currently taking:

    NOTE: Please leave any medications and instructions with camp nurse upon arrival. (Including OTC)