Registration:
—Please choose an option—Elementary School Camp 3rd-5thMiddle School Camp 6th-8thHigh School Camp 9th-12th

T-Shirt Size:
Youth: —Please choose an option—XSSMLXL

Adult: —Please choose an option—XSSMLXL

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

*Birth-date:

*Age:

*Grade:

MaleFemale

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.
I, the parent/ guardian agree

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.
I, the camper agree

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

I herein authorize the adult staff of Bethany Bible Camp to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis when need for such treatment is immediate, and when efforts to contact me are unsuccessful. I Certify that my child is free from communicable diseases, including COVID-19.

Emergency contact info:

Health Insurance info:

Family Physician info:

Health History - Check all medical/food allergies, chronic conditions, or medical problems that apply:
DiabetesSleep WalkingPoison IvyEpilepsyEar/Throat InfectionsHay FeverHeart ProblemsInsect StingsAsthmaAllergies

Other Food or drug allergies

Other conditions:

*Last tetanus shot:

*Last physical:

Activity Limitations:

Medications the camper is currently taking:

Please check if Mumps, Measles, Rubella, Polio, Diphtheria, and Pertussis immunizations are current.

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

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