BCC Youth Dorm 2019 Registration
**DO NOT TRY TO PRINT THIS FORM FROM THIS PAGE**
You will be emailed a printer-friendly version of this form once you complete/submit.

Payment can be made using PayPal on the Camp Website or by mailing to Brown City Camp.

A Health History Form will be emailed also, you will need to complete and bring it to camp!!

Contact Information
Camper's First Name *
Your answer
Camper's Last Name *
Your answer
Camper's Gender *
Camper's Age *
Your answer
Camper's Last Grade *
Provide grade completed in June.
Your answer
Camper's Birth Date *
MM
/
DD
/
YYYY
Roommate Request
We will do our best to accommodate housing request but make no guarantee.
Your answer
Camper's - Additional Information
Include Legal Guardian's name if you are not, Food Allergies, Medical Conditions, Special Needs & on-camp emergency contact & cell phone # if different than yours.
Your answer
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Email *
Your answer
Parent's Cell Phone Number *
Example: xxx-xxx-xxxx
Your answer
Mailing Address *
Your answer
Address Line 2
Your answer
City *
Your answer
State/Prov. *
Zip/Postal Code *
Your answer
Country *
Your Home Church
Home Church Name
Your answer
Home Church Denomination
Additional Comments/Notes
Leave any additional notes or details that we may need to know here.
Your answer
Submit
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