ADULT & FAMILY Registration for WV Trip- June 16-23

July 16-23, 2018 | Please fill out this form and click submit.

Registration forms and T-Shirt sizes are due by Sunday, April 29, 2018 to receive preference for your placement. Registration will remain open after 4/29.

Questions? Please contact: Dan Cameron at 724-854-3052 or Nate Childers 724-974-9250.

We do not want to see anyone not going because of finances. Contact those below if there is a financial need.

Payment is cash or check (made out to "Bethany Church") by mail (Bethany Church, Attn: WV Trip, 100 W. Venango Street, Mercer, PA 16137) or in person at the Bethany Office on Monday-Friday from 8 am-12 pm and 1 pm-4 pm.

Final balance is due June 6, 2018.
Adult and family participants: are not required to make the same financial commitment to the mission trip because of their own travel expenses. Although a monetary donation at any level is encouraged. Checks are payable to “Bethany Church” (note WV Mission Trip on memo).

We do not want to see anyone not going because of finances.

Registration forms and T-Shirt sizes by Sunday, April 29, 2018.

Registration will remain open after 4/29.

Questions? Please contact: Dan Cameron at 724-854-3052 or Nate Childers 724-974-9250.
Adult/Family Information (children in middle school and younger):

 
 
 
 
 
 
 
 
 
 
 
Please select all that apply.
Please select all that apply.
General Information (everyone)

All the information below (general, health, releases, payment) needs to be completed whether you are a student or adult/family attending.
 
 
 
 
 
 
 
 
Health Information (everyone):

 
 
 
 
 
 
 
 
Liability Release:

I certify the above child has my permission to attend the WV Trip with Bethany Presbyterian Church (Bethany) to Circleville, WV and to participate in all activities. I also authorize Bethany to transport my child to offsite activities. I understand that Bethany will only release my child to the persons mentioned, unless written notification is submitted with updated camper information. I release Bethany, as well as employees and volunteers from any and all claims or liability arising out of this participation.
Please select one option.
Medical Release:

In case of medical emergency or general medical care, I understand every effort will be made to contact me. In the event that I cannot be reached, I give consent for medical treatment (medication, injections, X-rays, anesthesia, etc.) and care by a licensed physician or dentist for my child named above at my expense.
Media Release:

I understand that the image and/or voice of my child may be recorded while attending summer camp Camp with Bethany Presbyterian Church at Wesley Woods Camp. I give my consent to the use of any type of media recording of my child for any editorial and/or promotional material by Bethany Church and/or partnering organizations while attending Wesley Woods Camp.
Please select all that apply.
Payment

Payment is preferred by check in mail (Bethany Church, Attn: WV Trip, 100 W. Venango Street, Mercer, PA 16137) or by check/cash in person at Bethany Office (M-F from 8 am-12 pm and 1-4 pm).

Description

July 16-23, 2018
Please fill out this form and click submit.

Registration forms and T-Shirt sizes are due by Sunday, April 29, 2018 to receive preference for your placement. Registration will remain open after 4/29.

Questions? Please contact: Dan Cameron at 724-854-3052 or Nate Childers 724-974-9250.

We do not want to see anyone not going because of finances. Contact those below if there is a financial need.

Payment is cash or check (made out to "Bethany Church") by mail (Bethany Church, Attn: WV Trip, 100 W. Venango Street, Mercer, PA 16137) or in person at the Bethany Office on Monday-Friday from 8 am-12 pm and 1 pm-4 pm.

Final balance is due June 6, 2018.