Scholars Night at Bethel

Si necesita ayuda en cualquier momento durante estas comunicaciones, por favor comuníquese con Robert Ortiz en robert.ortiz@betheluniversity.edu o al 574-807-7056.

Student Information

Student First Name

Preferred First Name (Ex: Anthony goes by Tony)

Student Last Name

Birthdate

Student Gender

Are you enrolled in the 21st Century Scholar Program

Yes

I don't know

Email Address

Student Cell Phone

Does Bethel University have permission to occasionally text you?

Yes

Do you give permission for Bethel's AI Assistant to connect with you?

Yes: Emails, Calls, Texts

Yes: Emails Only

No: Emails, Calls, Texts

Mailing Address

Country

Street

City

Region

Postal Code

What size tshirt do you prefer?

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Type

Parent/Guardian Email

Is this parent/guardian a graduate of Bethel?

Overnight Waiver / Consent

LIABILITY WAIVER

I give my child/dependent permission to participate in an overnight stay at Bethel University. I understand the possible risks associated with such an event, including transportation to and from campus, to which my child/dependent may be exposed. I agree to assume all responsibilities surrounding my child/dependent's participation in this visit. I release Bethel University and its employees against any and all claims, demands and actions which may result from damage to property or personal injury due to my child/dependent's participation in this overnight stay, beyond the control of, and without the fault or negligence of Bethel University or its employees.

MEDICAL CONSENT

I hereby consent for my child/dependent to be given medical treatment as may be deemed necessary by a physician in the event of injury, accident, or unexpected illness. I understand that Bethel University will not be held responsible for any financial obligation incurred related to medical treatment. I understand that an attempt shall be made to contact in such an event.

Please list any current allergies/medical conditions that we should be aware of:

Emergency Phone

In place of your signature, please type your first and last name (parent)