Online Registration for Youth Summer Camps

Only one camper per submission.  All registration requests and credit card payments submitted through this website are secured by GeoTrust. Just complete the required information below and follow the five easy steps.  If you do not enter any of the required fields, you must use the BACK button in your web browser to return to this page and fill in the additional information.  (Not using this feature will result in deletion of previously entered data). 

 

Step 1: Camper Information:
(* indicates required fields)  
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  Camper Last Name:*
First:* MI:
  Birthday (MM/DD/YY)*
 Gender:*
 
  Grade Completed:*
    
  Church Attending:
 

Roommate Request:

(Limit of one name.  Cannot be more than 2 years difference in age)
(Not available for Red Barn Horse Camps as campers are placed in groups by ability)

 
 
  Street Address:*
  City:*
 State:*
Zip code:*
 
   
       
  Parent1/Guardian Last Name:*
 First:*
  
  Home phone:*
Work phone:*
 
  Cell/Pager phone:
 
  Email:
 
  If you do not want to receive future email information of upcoming Camp Berachah events please initial here.  
  Parent2/Guardian Last Name:
 First:
  
  Home phone:
 Work phone:
 
  Cell/Pager phone:
  
  Email:
 
  Emergency Contact Name:*
  
  Emergency phone:*
  How did you hear about us?
       

Step 2:  Medical information and adult consent for minors:
  • All prescription and over-the-counter medications must be turned in at check-in upon arrival to camp. All prescription medications must be in the original pharmacy bottle, labeled with the patient name and physician's ordered dose on the bottle (e.g., pills in Ziploc baggies are not okay. Non-prescription/over-the-counter medication, including vitamins and herbal supplements, must also be in their original containers. Campers are allowed to carry one inhaler with them at camp, if medically necessary.

 

  • If you would like your camper with special needs to be considered for summer camps, please print off the prescreening application and send to Natalie Head, email nhead@campberachah.org Special Needs Coordinator at Camp Berachah. Click here for 2008 SN Application  « link to a Word Document

 

The following over-the-counter medications are dispensed during our summer camp sessions as needed: acetaminophen, ibuprofen, antihistamine, throat lozenges, anti-nausea, anti-diarrhea, antibiotic ointment, anti-itch cream, ipecac, aloe, eyewash, and sunscreen.

Please list any exceptions to the over-the-counter drugs
listed above, allergies & reactions:*

Please list any allergies or dietary restrictions (and reactions):*

Current Medications:*
Current Medical Conditions:*
 

Tetanus Booster up-to date?*

Immunizations up-to date?*
       

Parent/Guardian Release is required.  Please read the following statement: 

"My child has my permission to participate in all activities on or off the grounds.  In case of a medical emergency for my child, I hereby authorize Camp Berachah Staff to act in their best judgment to seek medical attention through appropriate means, including emergency room treatment as deemed appropriate by attending medical personnel.  I also accept responsibility for expenses incurred through such treatment." AND "I give permission for Camp Berachah to use any photo or video of my family in publications.  I release my right to any kind of remuneration for said photos."
If you agree please type your initials here:**

 
 

Step 3: Select Your Session(s):

Classic Day Camp Sessions:

 

Thursdays include Parent Night which begins at 5:40pm!

  
(Multiple Selections allowed, hold CTRL while selecting)
 Options:
 

Overnight Sessions:

  
(Multiple Selections allowed - hold CTRL while selecting)
Overnight Camp Options:
   

Buck Creek Wilderness Camp Sessions:

  
(Multiple Selections allowed - hold CTRL while selecting)
  
   

Overnight Horse Camp Sessions:

 
Fridays include "Game Day" from 1:00 to 3:00pm, family invited, bring your camera!
(Multiple Selections allowed - hold CTRL while selecting)
 Overnight Horse Camp Options:
   

Red Barn Horse Day Camp Sessions:

  
Fridays include "Game Day" from 1:30 to 3:30pm, family invited, bring your camera! 
(Multiple Selections allowed - hold CTRL while selecting)
  
   

WIT (Wrangler In Training) Sessions:

  
To qualify as a WIT, you must demonstrate the ability to control the horse at a walk, trot and lope with a reasonable safe and balanced seat--as well as catch, groom and saddle with minimum supervision. Call Dawn or Kim at 253-939-0488 ext. 105 or 213 for a screening phone interview before registering. 

(Multiple Selections allowed - hold CTRL while selecting)

  
   

CIT (Counselor In Training) Sessions:

  
Hold CTRL while selecting multiple sessions
CIT Options:
   

Additional Registration Notes or Comments:

  
   

Step 4: Provide payment information:
Payment information

All online registrations require a $35.00 non-refundable/non-transferable deposit per session to process
(which will be applied to the camp fee).

 
GeoTrust Name on card:*
  Amount Paying:*
 Card Type:*
  3 digit verification number from the back of your card:*  
  Card Number:*

format:  xxxx-xxxx-xxxx-xxxx

Expires (MM/YY):*

 

 

 

 
  AUTO CHARGE:  Would you like us to automatically charge the balance to your credit card when due 14 days before the camp session begins?*
CAMPER SCHOLARSHIP FUND:  Would you like us to charge your card an additional amount to help someone else have the opportunity to attend camp?  Enter amount:
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Step 5: Please make note of the following registration policies:

  • REGISTRATIONS:  Subject to space availability and cannot be processed without accompanying credit card information authorizing payment of either the required minimum non-refundable/non-transferable deposit of $35 (per camper for each camp session) or payment in full.

 

  • CONFIRMATIONS:  Look for your confirmation notice in the mail within 14 days.  If you do not receive a confirmation 2 weeks after you have registered, please contact our office to verify we received your registration.

 

  • PAYMENTS:  Full payment must be received at least 14 days before the start of the camp session (including any extended care or transportation fees), or you may lose your spot.  Additional credit card charges may be submitted by phone or online through our second payment option.  No payments can be accepted at check-in.  If payment is not received, this will be considered a cancellation and the spot is opened up to those on our waiting list.  We usually have an extensive wait list for each camp session, and this allows us adequate time to contact those who wish to fill those relinquished spots.  Please call us if you know your balance will be unpaid within 14  days of the first day of camp so we can work with you to ensure your child has a camp experience. 

 

  • CHANGES/CANCELLATIONS: All changes and cancellations must be made in writing.   Send  notice via Email to register@campberachah.org  -  Fax to 253.833.7027  -  or by US MAIL to 19830 SE 328th PL Auburn, WA  98092.  Refunds (minus the $35 non-refundable deposit) will be issued within 30 days of cancellation notice. 
     
  Send email to Registration Send an email to Camp Office
  Return to Summer Camp Information Page for packing lists  
     

Thank you for registering online for Camp Berachah's summer camps!

If you did not enter any of the required fields, you must come BACK and complete.
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