Online Registration for Youth Events

Please complete the required information below.  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 a deletion of all previously entered data.)

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.  No payments can be accepted at check-in. 
  • 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.  Any approved refund amounts will be issued within 30 days of cancellation notice. 

Camper Information:
(* indicates required fields)
secured site      
  Camper Last Name:*
First:*
MI:*
  Birthday (MM/DD/YY)*
 Gender:*
 
 

Grade Completed:*

   
 

Church Attending:

 

Group-mate Request:


(Limit of one name. Cannot be more than 2 years difference in age)
 
 

Street Address:*

 

City:*

State:*

 
 

Zip code:*

   
  Parent1/Guardian Last Name:*
 First:*
  
 

Home phone:*

Work phone:*

 
 

Cell/Pager phone:

Email: * (required for confirmation)
  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?
       

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 SN Application.

 

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:*

 

Select Your Session(s):
(Multiple Selections allowed - hold CTRL while selecting)  

 

Extended Care Options:

 

Additional Registration Notes or Comments:

  

After submitting this registration information,
you must make a payment to complete the process.

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