Welcome to the Beautiful Pacific Northwest

                      

 
Berachah at Buck Creek Open House - June 8 from 2-5 pm!

     

   2008 Summer Camp Registration

Online Registration for Youth Summer Camps
(Works best with Microsoft Internet Explorer - those using Mozilla Firefox are experiencing text overlays)

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)

Camper Last Name*:

        First*: MI:  
Birthday (MM/DD/YY)*: Gender (boy/girl)*:
Grade Completed*:
Church Attending:

Group-mate 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*:
Parent1/Guardian Last Name*: First*:
Home Phone*: Work Phone*:
Cell/Pager Phone: Email:

Please enter your email address for an auto-responder confirmation that we received your registration request. 

This does not guarantee your camper is registered.  If you do not want to receive future email information 

of upcoming Camp Berachah events and activities please initial here 

Parent2/Guardian Last Name: First:
Home Phone: Work Phone:
Cell/Pager Phone: Email:
Emergency Contact Name*:  Phone*:
How did you hear about us?*:   
Step 2:  Medical information and adult consent for minors:

  • 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 2007 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."          

Parent/guardian initial here: *

 
Step 3:  Select Your Session(s): 
 (Hold CTRL for multiple sessions in each selection box or to unselect)
 
Classic Day Camp Sessions:    	    	Classic Day Camp Options:    
*Available for Special Needs campers   No Horse Rides available for following sessions: 
                                       D003
   
Overnight Sessions: 				Overnight Session Options:    
                                                                                         No Horse Rides available for following sessions:
                                                                                         J103
  	    Not available for J103
 
Overnight Horse Camp Sessions:   	                     Overnight Horse Camp Options
Sessions H004 & H008 are for riders                             New for 2008! - Extra Lesson Tracks (ELT) - 
          who have passed CHA Level 1		                  	       Includes 4 extra lessons added to the Horse Camp
						       week-small class size, geared for campers who 
						       want more individual instruction.  
     	
	
  
      	
 
Overnight Sessions at Buck Creek Wilderness Camp:
(Located near Crystal Mountain-Check in/out at Buck Creek)



Red Barn Horse Day Camp Sessions: (No bus transport or extended care)

 
 
 
 
 
 
 
 
 
 
 
 
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-CHA Level 2 skills required. Call Kathy or Kim at 
253-939-0488 ext. 105 or 213 for a screening phone interview before registering. 

 

      
CIT (Counselor In Training) Sessions: 
To qualify as a CIT, you must complete the CIT application process                 
and be accepted before you register.   click here for 2007 CIT Application  
We will not be accepting CIT applications until January 2, 2008.
					CIT Options:
      
 
 
	
 
Additional Registration Notes or Comments:


Step 4:  Provide payment information:

Card Number* (xxxx-xxxx-xxxx-xxxx):   Visa, Mastercard, Discover ONLY

Card Expires *(MM/YY):        3 digit verification on back of card: 

Name on Card*:  
 
Payment Amount*:    

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

AUTO CHARGE:  Would you like us to automatically charge the balance to your credit card when due 14 days before each camp session begins?* (If no, 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.)

 

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:  

 


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.  

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.
Use the BACK arrow in your web browser. 
Registering more than one camper? After pressing submit, use the back button
to come back to this page and update information for the next camper

Click here for Packing Lists and Check-In Information  « link to a Word Document

Click here to print a Summer Registration Form « link to a Word Document