Student Life Camp 2026 Registration & Deposit Form

Sign your children up below to attend Student Life Camp at Eagle Eyrie Conference Center in Lynchburg, VA from July 27-31, 2026!

The total cost for camp is $400 for your first child and $300 for each additional sibling, but the only amount required when completing this form is the deposit amount of $125 (however you can pay in full at this time if you prefer).

Deposit is due by January 15th, and full payment is due prior to leaving camp.

Student's Full Name

Parent's Full Name

Parent Email

This address will receive a confirmation email

Parent Phone

Emergency Contact Name & Phone Number

Allergy/Medical Information

In the event of a medical emergency, I authorize the adult leaders and representatives of Bethany Baptist Church to seek medical treatment for my child. This includes, but is not limited to, first aid, medical care by licensed professionals, and transport via ambulance or emergency services if deemed necessary. I understand that every effort will be made to contact me immediately in the case of an emergency. Sign your name below if you agree to these terms.

I give permission for my child to be transported to and from the event in the Bethany Baptist Church van or other church-approved vehicle driven by authorized adult leaders. Sign your name below if you agree to these terms.

I grant permission for Bethany Baptist Church to take photographs and/or video of my child during this event. I understand that these images may be used in promotional materials, on church social media platforms, and in internal presentations. Sign your name below if you agree to these terms.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

July 27-31, 2026

Please fill out this form and click submit.

Student Life Camp 2026 Registration & Deposit Form

Description

Please Fix the Following