1st – 8th Grade Summer Camp Registration (2025)

Parent's First Name *

Parent's Last Name *

Parent's Email Address *

Parent's Phone Number *

Student's First Name *

Student's Last Name *

Student's 2025-2026 Grade Level *

Student's Date of Birth *

Select ALL weeks you would like to register your child for. You will be billed for all weeks you choose. If you need care for a week you do not choose, the fee is $30 more and will be based on availability.

Week 1 (6/4-6/6) Prorated

Week 2 (6/9-6/13)

Week 3 (6/16-6/20)

Week 4 (6/23-6/27)

Week 5 (6/30-7/02) Prorated

Week 6 (7/07-7/11)

Week 7 (7/14-7/18)

Week 8 (7/21-7/25)

Week 9 (7/28-8/01)

Do you consent to the use and reproduction by BCS of any and all photographs and any other audio/visual materials taken of your child listed above for promotional material, educational activities, and exhibitions or for any other use for the benefit of the school. This includes posting of pictures on the official BCS Website and Facebook Page.

Yes

Is your child enrolled as a student at Bethany Christian School? *

Yes

How did you hear about Camp Bethany? *

BCS Website

Previously Attended

Other...

May we administer Topical Medications to your child? *

Yes

May we administer Sunscreen to your child? *

Yes

Would you like to purchase a camp shirt for your student for $18? *

Yes

Select Your Child's Shirt Size - REQUIRED EVEN IF NOT BUYING A SHIRT *

Physician's Name *

Physician's Phone Number *

Please provide the name of your child's Health Insurance Company and Policy Number. If none, type N/A *

Does your child have any special allergies, health problems, medications (including Ritalin), or required accommodations we should be aware? *

List the first and last name of ALL Parents and/or Legal Guardians, including their cell phone number and relationship to the child, for purposes of contact in the event of an emergency. We will contact IN THE ORDER you provide. *

List the first and last name, cell phone number and relationship to the child, of ALL persons AUTHORIZED to pick your child up from camp. ANYONE NOT listed will be prohibited from picking up your child. *

In consideration for being accepted at Bethany Christian School for participation in Bethany Christian School Summer Camp trips/activities, we, being twenty-one years of age or older, do, for ourselves, and for and on behalf of my/our child participate (herein referred to as Participant) if said participant is not twenty-one years of age or older, do hereby release forever, discharge and agree to hold harmless Bethany Christian School and the directors thereof from any and all liability, claims or demands of personal injury, sickness or death, as well as property damage and expense, of any nature whatsoever which may be incurred, as the result of the negligent, willful or intentional acts of said participants including expenses incurred attendant thereto,

Furthermore, we (and on behalf of our/my participant if under the age of twenty-one) hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein.

The undersigned further hereby agrees to hold harmless and indemnify said school directors, employees and agents for any liability sustained by said school as the result of the negligent, willful or intentional acts of said participants including expenses incurred attendant thereto.

I/We have read the foregoing and understand the rules of conduct for participants and will abide by them as well as the directions of the leaderships of the activity.

PARENTAL CONSENT

TO WHOM IT MAY CONCERN: The undersigned do (does) hereby give permission for my (our) children listed above to attend and participate in activities sponsored by Bethany Christian School.

I (we) authorize an adult, in whom CAMP of the minor has been entrusted, to consent to x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment in hospital CAMP, to be rendered to the child/minor under general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Florida Medical Practice Act on the medical staff of a licensed hospital, whether surgical diagnosis or treatment is rendered at the office of said physician or at said hospital.

The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child/minor or pursuant to this authorization.

Should it be necessary for my (our) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The undersigned does also hereby give permission for my (our) child/minor to ride in the vehicle designated by the adult in which CAMP the child/minor has been entrusted with during and participating in activities sponsored by Bethany Christian School.

“Under penalties of perjury, I declare that I have read the foregoing (document) and that the facts stated in it are true.”

This form shall be in effect until the student is withdrawn from Bethany Christian School.

Sign in the box below to confirm. You will receive a copy of all documents via email.

Click submit to be directed to the payment page and complete your registration. Registration fees and T-shirt cost (if applicable) will be charged today.