Camp Bridgeway September 2025 Registration Form

Please complete the form below to finalize your camper's registration. A separate form must be completed for EACH child. Please note that campers must be in the 6th-12th grades in order to attend.

Camper's Legal Name*

First NameLast Name

Birth Date*

MonthDayYear

Age*

Grade Level (for the 2025-2026 school year)*

Sex*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name*

First NameLast Name

Home Number

Cell Number*

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number*

What is your child's t-shirt size? (These are adult sizes)

How did your child hear about the camp?*

A friend invited them to go with themThey heard about it at churchAttended Camp Bridgeway in a previous yearOther

If your child was invited by a friend, which friend invited them?*

What church does your child attend?*

If you selected "Other" - what church does your child attend?

Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Does your child have any developmental, emotional, or behavioral conditions that would require special accommodations? If yes, please describe. Please note that our staff serve on a volunteer basis and have not been formally trained on how to work with students with disabilities. As such, we are very limited in the types of accommodations we can provide. *

Is your child prescribed an inhaler? If yes, please explain any instructions.*

Does your child take any medications? If so, please list them here along with the dosage and frequency that the medication must be taken. All medications must be in their original containers and be appropriately labeled. All medications will be held and administered by the camp nurse.*

We will have topical ointments available for minor cuts, bug bites and sunburns. Are we allowed to administer these to your child?*

YesNo

Are we allowed to administer sunscreen to your child?*

YesNo

Are we allowed to administer Tylenol to your child?*

YesNo

Are we allowed to administer Ibuprofen to your child?*

YesNo

Are we allowed to give Tums to your child?*

YesNo

Are we allowed to administer Pepto Bismol to your child?*

YesNo

Are we allowed to administer Benadryl to your child in case of an allergic reaction?*

YesNo

Does your child have any dietary restrictions? If so, please explain any instructions*

Who are the people that are allowed to pick up your child from camp? Please list their full names and their relationship to the camper.*

Is your child covered by family medical/hospital insurance?*

YesNo

Insurance Carrier or Plan Name*

Insurance Group #*

Insurance Address*

Name of Insured*

Relationship to Camper*

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Bridgeway Youth Program Specialists, Inc. during the selected camp. In exchange for the acceptance of said child’s candidacy by Bridgeway Youth Program Specialists, Inc. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Bridgeway Youth Progam Specialists, Inc. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Bridgeway Youth Program Specialists, Inc. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Please indicate you understand and agree to this informed consent.*

I agree.

Medical Release and Authorization

As the parent and/or legal guardian of the named student, I hereby authorize qualified and licensed medical professionals to diagnose and treat the minor child in the event of a medical emergency. This authorization is granted when, in the professional opinion of the attending medical personnel, immediate attention is necessary to prevent further endangerment of the minor's life, physical disfigurement, impairment, or undue pain and suffering.

I consent to any necessary medical treatment, including but not limited to medical or minor surgical procedures or x-ray examinations as deemed necessary by the attending physician. In the case of an emergency involving serious illness, major surgery, or significant accidental injury, I understand that reasonable efforts will be made to contact me as quickly as possible before proceeding with treatment. However, this authorization permits emergency care to proceed if I cannot be reached after a reasonable attempt.

Additionally, I grant permission to Bridgeway Youth Program Specialists, Inc., including its affiliates, directors, coaches, and volunteer staff, to administer or facilitate necessary emergency care prior to the child’s admission to a medical facility if such care is essential to the child’s immediate safety.

This authorization is valid for the duration of the registered season or activity. I understand and accept full financial responsibility for any medical expenses incurred as a result of treatment provided under this authorization.

This release is made voluntarily and with the intention of ensuring the minor child receives appropriate medical care in my absence.

Please indicate your consent to this medical release and authorization.*

I agree.

Media Release I hereby give my consent to all photographs, audio-recordings and/or video-recordings taken of me or my minor child by Bridgeway Youth Program Specialists, Inc. staff or their designees. I understand that any such photographs, audio-recordings and/or video-recordings become the property of Bridgeway Youth Program Specialists, Inc. and may be used by the organization, or others with their consent, for educational, instructional, or promotional purposes determined by the organization in broadcast and electronic media formats now existing or in the future created.

Please indicate your consent to this media release.*

I agree.

CELL PHONES AND ELECTRONICS I understand that cell phones and electronics are NOT permitted at camp. If phones are found, they will be confiscated and returned at the end of the week. In case of an emergency, all leaders will have a cell phone available for student use. Parents are able to contact Kayse McCanne (Camp Director) at 770-364-2995. This is to ensure that students have an opportunity to “unplug” and focus on God and build stronger friendships with their peers this week.

Please indicate you understand the cell phone and electronics policy.*