BETHLEHEM ACADEMY REGISTRATION FORM 2024 Summer Camp June Tuition: $500.00 (If you have already paid the tuition deposit, payment due is $450.) Due date: Must be paid in full no later than May 24th ~~ July Tuition: Amount $500 Due Date: Must be paid in full no later than June 21st.

Student Name *

Age *

DoB *

Address *

Zip *

Last Grade Completed *

Please enter T-Shirt size *

Parent 's Name *

Phone Number *

Email *

2nd Parent/Guardian:

Phone Number *

Email

Emergency Contact: *

Relationship *

Name and Phone number(s) of person(s) other than parents allowed to pick up your child

	you must have at least one item
1.	you must have at least one item
2.	you must have at least one item
3.	you must have at least one item
4.	you must have at least one item

Please list any information you'd like to include about your child:

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