Intermediate Camp | Bethany Farm Camp

top of page

Home
Our Ongoing Projects
Summer Camps
FAQ
Registration Material
Counselor Application
Winter Camp
Contact
Staff
History
Donate to Wodickers
Donate to Jordans
Donate to Bethany Projects
More

Use tab to navigate through the menu items.

Registration-Summer Camp

First Name

Last Name

Male/Female

Street Address

City

Parent/Guardian Name

Parent/Guardian Phone

Parent/ Guardian's Email

Emergency Contact Name

Emergency Contact Phone Number

Date of Birth

Grade Entering This Fall

Allergic Reaction/Drug Allergies

Most Recent Tetinus

Regular Medication Instructions

Activity/Dietary Restrictions

Permission To Administer Over-The-Counter Drugs

Drug Brands

Dosage

Family Doctor Name

Insurance Provider Company

Policy Number

Insured"s Name

Any Other Medical Information

Donate to the Wodickers

Donate to the Jordans

Donate to the Projects

bottom of page