Bethel Baptist Association

Worker Registration

*Required Information

Please choose which camp you will be working *

	Youth Camp (Grade 7-12)
	Childrens Camp (Grade 3-6)
	Kids Day Camp (Grade K-2)

Name *

Date of Birth mm/dd/yyyy

Gender

	Male
	Female

Sponsoring Church / Association *

T-Shirt Size *

Email Address *

Home Phone

() -

Work Phone

() -

Cell Phone

() -

Street Address

City

State

Zip

Message to Camp Director

Important messages that may also include a request for cabin assignments.

Dietary Needs / Food Allergies

IMPORTANT: Please list all food allergies, dietary needs and any information we may need.

Message to Camp Medical Person

List special allergies, physical medical concerns, mental health concerns, and/or any medicine instructions.

Note: All medicine MUST be in original container(s) with complete instructions and MUST be turned into Camp Nurse during registration/check-in. DO NOT send Tylenol, or Ibuprofen, as these are provided.

If needed may Tylenol, or Ibuprofen be given by the Camp Nurse? Please specify preference.

Emergency Contact*

Name
Relationship
() - Phone Number

Alternate Emergency Contact*

Name
Relationship
() - Phone Number

Physicians Name

Insurance Company

Church Member?

	Yes
	No

Church Name

Christian?

	Yes
	No

Baptized?

	Yes
	No

Your Testimony *

Please tell us your testimony of how you met Jesus and how He has changed your life:

Your Church Involvement *

Please elaborate and explain all questions.

How often do you attend your church? Are you involved in other activities at your church? Are you involved in children or youth ministry?

Your Desire for Leadership *

Why do you want to attend camp as a leader?

Age

Indicate Age at Time of Camp.

Camp Guidelines Agreement *

Mark the checkbox only if you have read and agree to the Camp Information and Camp Guidelines.

1. Camp Information
2. Camp Guidelines

I have read and agree with the Camp Information and Camp Guidelines.

Your Signature *

I, the undersigned applicant, do hereby give consent for any emergency care deemed necessary by Bethel Baptist Association Camp leaders and/or the medical facility(ies) to which I am taken. I further agree to release Bethel Baptist Association and its representative from liability for any injury or mishap which may occur at camp, including accident which may occur during transportation to or from camp. I further agree to voluntarily provide my medical information to camp administrators according to HIPA.

High School Workers - Please note that we only have a limited number of spots for high school workers.

IMPORTANT: Note that your registration with this form does not guarantee approval. Workers have to be an ACTIVE church member and MUST be approved by the Camp Director. The Camp Director will contact you to confirm or deny your worker registration via email or phone.

Sign by indicating your name or email address.