Bethlehem Evangelical Lutheran Church Logo

Bethlehem Vacation Bible Camp Registration Form

All children are asked to bring a plain, clean, white t-shirt to Camp no later than Wednesday, August 6th. Be sure your child’s name is clearly marked on it. Thank you!

*** Due to available space, attendance for Preschool children (ages 3-5), who are toilet trained and have not attended Kindergarten, has been limited to 20 students. Attendance for children age Kindergarten to Grade 5 is limited to 60 students. If you are not able to attend once you’ve registered, please notify us as soon as possible so that we may contact persons on the waiting list. Thank you for this courtesy! ***

Register below, or call 703-361-4866.

"*" Indicates a required field that must be filled in.

Child's Name*
Grade
Birthday
Age
  
Parents' Name(s)*
Home Address
City, State, ZIP
Home Phone*
Alternate Phone
E-Mail Address
  
Emergency Contact
Relationship to Child
Home Phone
Alternate Phone
  

People who may pick up your child(ren):

Please list any food allergies or medical concerns: