Esports Camp

BLC Esports is June 19-20, 2025. The cost is $195 per camper and includes a dorm stay and meals.

You may only register one family with this form. If you need to register others, please fill out this form once for each family.

All fields are required. Please contact Coach Fricke with questions.

Parent/Guardian Name Parent/Guardian Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian Phone
Parent/Guardian Email
Number of children attending

Number of children attending One ($195) Two (+$390) Three (+$585)

You may only register children from one family using this form. If you need to register children from another family, please fill out a second form.
Student #1 Name Student #1 Name First Last
Student #1 Date of Birth Student #1 Date of Birth / MM / DD YYYY
Student #1 High School Name / City
Student #1 Grade (Fall 2024)

Student #1 Grade (Fall 2024) 9th Grade 10th Grade 11th Grade 12th Grade
Student #2 Name Student #2 Name First Last
Student #2 Date of Birth Student #2 Date of Birth / MM / DD YYYY
Student #2 High School Name / City
Student #2 Grade (Fall 2024)

Student #2 Grade (Fall 2024) 9th Grade 10th Grade 11th Grade 12th Grade
Student #3 Name Student #3 Name First Last
Student #3 Date of Birth Student #3 Date of Birth / MM / DD YYYY
Student #3 High School Name / City
Student #3 Grade (Fall 2024)

Student #3 Grade (Fall 2024) 9th Grade 10th Grade 11th Grade 12th Grade
Liability Waiver

I give permission for my child/children, specified on this form, to attend Bethany Lutheran College’s Esports Camp. I understand that all reasonable and prudent safety precautions will be taken during the event and I understand the counselors and camp directors will not be held liable in case of accident or injury. I will be responsible for providing insurance for my child/children.
Liability Signature

Draw or Type

Clear

Full Name
Payment

Please be sure to complete your payment on the next page in order to register for this camp. You should receive a confirmation email after payment is received. Registrations without a completed payment will be considered incomplete.
$0

Total

Esports Camp

Esports Camp

Liability Waiver

Payment

$0

Total

$`0`