Student General Information
Student's Name: *
Student's Name:
Student is: *
Date of Birth: *
Date of Birth:
Student's Address: *
Student's Address:
Phone Number: *
Phone Number:
* If Health Card number & expiry is not provided, an invoice will be sent directly to the parent/guardian for any medical expense incurred by camp staff or volunteers with expectation of reimbursement.
Parent/Guardian Information
Parent/Guardian #1 Name: *
Parent/Guardian #1 Name:
Same Address?: *
If no write here:
If no write here:
Cell Phone: *
Cell Phone:
Work Phone: *
Work Phone:
Parent/Guardian #2 Name:
Parent/Guardian #2 Name:
Same Address?
If no write here:
If no write here:
Cell Phone:
Cell Phone:
Work Phone:
Work Phone:
In an event where the parent/guardian cannot be reached in the unlikely event of an emergency, please indicate another emergency contact for your student. This contact must be over the age of 18 and should have a personal relationship to the student and/or guardian (i.e. not a family doctor).
Emergency Contact Name:
Emergency Contact Name:
Cell Phone:
Cell Phone:
Work Phone:
Work Phone:
Medical Release Information
Does your child have any allergies? *
Please note: The information given in this section of this form is final. Students will NOT, for any reason, be allowed to change their accommodations once they are at camp, whether situated in a private cabin or a provided cabin.
By checking this box you understand and agree to print and sign the Student Code of Conduct, Media Release Form and Waiver and that failure to do so and present upon bus boarding and/or camp drop-off will result in not being able to take part in youth camp *
The forms are available for download on the YOUTH CAMP page, Youth Camp Facebook group as well as above.
Payment Options: *
Cheques MUST be made out to “Bethel Park Next Gen” Failure to do so will result in you receiving an email that you must send a new one; the previous one will be destroyed. This will delay the registration of your child. If the replacement cheque is received after the early-bird deadline, you will be expected to pay the standard rate. For E-transfers Send to: bookkeeper@bethelpark.ca Security Question: What is the camp retreat theme? Answer: reach Note: answer is case-sensitive; use all lowercase letters IMPORTANT NOTE: Any Email Money Transfers made to any other email address will NOT be accepted. We will NOT accept the email transfer if you do not use this given security question and answer. If you choose to use another security question and answer, this will delay the registration of your child. Only when the correct security question and answer are used will your money be accepted. If this occurs after the early-bird deadline, you will be expected to pay the standard rate
Registration is not complete until payment is received in Full *
Registration Cost is $165
Please add up your registration deadline cost, t-shirt and bus add-on costs here
$