BETHLEHEM ACADEMY REGISTRATION FORM 2024 Summer Camp Tuitions $50.00 deposit toward tuition - Due May 31, 2024

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 *

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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