Date: July 18-24
Participant's Full Name *
Address *
Email *
Phone Number *
Birthday *
Age *
Gender *
Is the participant a member of Bethesda? *
Has the participant attended Salkehatchie or Santahatchie before?
What does the participant have experience with? *
Does the participant have any restrictions on what they can do? *
Do they have any dietary restrictions?
Do they plan to volunteer as an adult leader?
Clear selection
What size t-shirt does the participant need? *
Consent for participation, release of Liability, and Indemnification Agreement
Please be aware: Bethesdahatchie involves experiences which have certain risks and hazards associated with it. These risks include but are not limited to, the use of power and hand tools, building repair hazards, normal household hazards, and infectious diseases.

I hereby give approval for our youth to attend and participate in Bethesdahatchie during 2021. In consideration for my youth participant being allowed to attend and participate in this activity, I, knowingly and freely assume all risks and hazards related to the Bethesdahatchie activities including, but not limited to, transportation to and from the Bethesdahatchie camp and service sites, even if arising from the negligence of those entities and persons released from liability below, and assume full responsibility for participation in Bethesdahatchie; further, I, for myself/ourselves and on behalf of our child and my/our heirs, do hereby release, discharge, and hold harmless Bethesda United Methodist Church and its trustees, officers, employees, and agents, as well as the organizers, sponsors, supervisors, counselors, chaperones, and other support staff persons for Bethesdahatchie (collectively referred to hereinafter as the “Releasees”), with respect to any loss, injury, or other damage to me and my child arising out of or in any way related to activities at Bethesdahatchie including, but not limited to, transportation to and from the Bethesdahatchie camp and service sites, whether caused by the negligence of the Releasees or otherwise, except that which is the result of gross negligence and/or willful or wanton misconduct. I further agree to indemnify and hold harmless the Releasees from any claims, losses, injuries, or other damages related to or arising from the above named participant’s attendance or participation in Bethesdahatchie including, but not limited to, any claims submitted by or on behalf of the participant.
I have read this release of liability and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement. *
Photo Release *
Do they have any medical conditions, allergies, or regularly scheduled medicine you have to take?
I understand that I owe $100 to attend this camp and will pay this in full before the camp starts. *
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