JHM > Winter Camp 2020

JHM Winter Camp 2020

Bethany Bible Church Junior High Ministry Event

Friday, January 10 – Sunday, January 12

This January, JHM is headed to beautiful Lost Canyon in Williams, AZ! Winter Camp is an incredible weekend filled with fun and games, friendly competition, and topped off with amazing worship and great Bible teaching!

Cost:

December 1-December 31 regular pricing of $180.

Note: Registration will close at the end of this year (December 31, 2019).

(The first $75 of each registration is a non-refundable deposit.)

Registration

1 Regular Registration for Winter Camp! ($180.00)
If you choose to pay the deposit only, the remaining balance will be automatically charged on the first day of camp.

Student Name

Preferred Email for Updates and Info

Preferred Phone Number

Grade

Gender

Shirt Size

Permission Slip & Medical Waiver

INSTRUCTIONS: If you are under 18 years of age, your parent or guardian must complete this section. If you are 18 years of age or older, you can complete this form for yourself.

Permission Slip for Any Church Related Function and Consent for Medical Treatment for Minors

The undersigned hereby gives permission for the above student to attend the JHM Winter Camp event with Bethany Bible Church. In the event there is an emergency involving my child, permission is hereby granted for Bethany Bible Church personnel to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in any state, and to consent to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment and hospital care to be rendered to the minor by any dentist licensed to practice in any state, and church personnel shall not be held personally liable.

(Typing my name in the space below serves as my digital signature.)

Signature of Parent or Legal Guardian (required for all minor registrants)

Address

Phone Number

Please provide the following information:

Emergency Contact Name

Emergency Contact Phone Number

Secondary Emergency Contact Name

Secondary Emergency Contact Phone Number

Attendee Date of Birth

Insurance Number

Insurance Company

Does the attendee take any regular medicine? If so, what?

Does the attendee have any allergies? If so, what?

Special Diet Request Form

If you have a special dietary restriction or request, the Lost Canyon Food Service Team desires to meet the needs of every guest that stays at their facilities. Please fill out their online form at this link.

Lost Canyon Waiver

*Please fill out this waiver in addition to the other information you are providing to BBC*

Young Life asks that each camper fills out their own Release Form prior to attending camp. This form must be printed, completed, and given to Matt Burkholder prior to our departure from BBC on January 10, 2020.

Download the Release Form PDF here.

Photography and Video Release for Minor Registrants

I acknowledge Bethany Bible Church and its representatives may take photographs and/or video of the minor who is being registered for this event and used by Bethany Bible Church for promotional needs, both in print and on the web. I know that in order to opt out I must contact Kellie Griffin at Bethany Bible Church at (602) 246-9788 or [email protected] with my opt-out request. I have full authority to authorize this release.

Registration Payment Total

Coupon Code

Total

$0.00

Billing Information

Name

Credit Card

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American Express
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Address

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