Junior Week Registration Form 2022

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Email *

Last Name *

First Name *

Age *

Gender *

Male

Female

Address *

Emergency Contact Name (Relationship) *

Emergency Contact Phone Number *

Medications *

Allergies *

Church You Attend

Camper T-Shirt Size (Each Camper Gets a Free Shirt!) *

I give permission and consent for photographs, video, and/or audio taken during Beeson Ministries events and activities of my person or child. I further give permission and consent that the likeness or image/audio of my person or child may be published and used by Beeson Ministries and its agents, to illustrate and promote the camp experience in print, electronic, and/or video format. I release all claims against Beeson Ministries with respect to copyright ownership and publication including any claim for compensation related to use of the materials. *

Yes

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