Summer Camp Enrollment Form

Camp BCC Registration

A Summer Day Camp Sponsored and Operated by the Barre Congregational Church
CAMPER INFORMATION:

You will need to fill out an additional form for each of your campers
Camper Name*

First NameLast Name
Camper Birth Date*
Camper's Gender*
Please select the week you wish to sign your camper up for. *
Program options*

CamperCIT (Counselor in Training)
If your camper will not be attending a full week at Camp BCC please explain below. Example: "Sally can only attend Camp BCC Mon, Wed, Fri for all 4 weeks because of dance."
Materials Fee

All four 2026 sessions of Camp BCC Summer Day Camp are offered free of tuition. To reserve your camper’s enrollment spot, we ask families to submit a $25 materials fee within two weeks of turning in their application.If the materials fee is not received, we will contact you and hold the spot for 24 hours. If we do not hear back within that time, the spot will be offered to another family.If this fee presents a financial hardship for your family, please reach out to our Program Director, Lydia, at (802) 476-3065 or bccuccoffice@gmail.com. We’re happy to work with you.
Grade*
Name of School*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

CityState

Zip CodeCountry
Phone Number*
E-mail*
example@example.com
How would you prefer to be generally conatcted?

Phone CallEmailText Message
Please list the names and phone numbers of anyone authorized to pick up your child from camp. Parent/Guardian 1 and Parent/Guardian 2 are automatically authorized; anyone else must be listed below. We need their first and last name, relation, and phone number.
Emergency Contact Information
Emergency Contact #1*

Parent/Guardian Name

Email

Home/Cell Phone NumberWork Phone Number

Home Address
Emergency Contact #2*

Parent/Guardian Name

Email

Home/Cell Phone NumberWork Phone Number

Home Address
MEDICAL INFORMATION
Physician Name*

First NameLast Name
Phone Number*
Medical Concerns
Health Care Carrier*
Policy #
Pleas check if apply

I do not currently hold a healthcare policy for my child
Allergies*

Yes my child DOES have allergiesNo my child does NOT have allergies
If yes, describe those allergies here and please include preventive measures and all medications your camper takes regarding their allergies:
Only answer if selected yes
Physical Limitations*

Yes, my child DOES have physical limitationsNo, my child does NOT have physical limitations
If yes, describe those physical limitations below:
Only answer if selected yes
Dietary Restrictions/Special Requirements*

Yes, my child DOES have special dietary restrictions/requirementsNo, my child does NOT have special dietary restrictions/requirements
If yes, describe those dietary restrictions/special requirements below:
Only answer if selected yes
Please list below anything else we need to know about your camper. Behavior issues, ADHD, sensory issues, emotional maturity, triggers, likes/dislikes, favorite game, etc.
Prescribed medications*

Yes, my child DOES take daily prescribed medicationsNo, my child does NOT take daily prescribed medications
During Camp prescribed medications*

Yes, my child DOES and WILL take prescribed medications while at campNo, my child does NOT and WILL not take prescribed medications at camp
If yes, list all prescribed medications below and what they treat:
If your child takes daily prescribed medications OR if you intend to allow your camper to be treated with non-prescription medications while at camp, upon your registration we will email you a copy of the medical medication release form for you to review, complete, and sign. We ask that you return this form to us on the first day of camp along with any of the child's required medications with the prescription document attached.
The Camp BCC Summer Day Camp Program requires immunization records on file for each camper or a pediatrician-signed form stating that the child is exempt from regular immunizations because of the family's moral or religious rights before admission into our program. If you are unable to provide immunization forms at the time of this application please forward them before the date of July 1st to bccuccoffice@gmail.com or mailed to 35 Church Street Barre, VT, 05641.
You may upload your child's immunization forms here or check the box below

Cancelof
Check the box below if you will be forwarding or snail-mailing your child's immunization records to the program director before July 1st.

Check here
Release of Liability & Medical Reasle: I assume all risks and hazards incidental to such participant and I hereby waive, release, absolve, indemnify, and agree to hold harmless The Barre Congregational Church, Camp BCC Summer Day Camp, and their employees or volunteers for any claim arising out of an injury to my child or myself.

I agree to be financially responsible for any property damage that my child directly caused during Camp.

In case of emergency. I hereby give my permission to the medical personnel selected by the Camp Director to order treatment and necessary transportation of my child. In the event that I cannot be reached in an emergency, I hereby give my permission to the physician to secure and administer treatment for my child.
Parent/Guardian Full Name and Signature Below*

First NameLast Name
Signature*

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Pleas check all that apply

YES, My child has permission to attend the rest of Camp BCC Summer Day Camp on walking field trips to Playground 2000, The Historical Museum, Currier Park, City Hall Park and Mathewson Playground.YES, I hereby give Camp BCC Summer Day Camp Staff and volunteers permission to take pictures of my child at camp for the sole purpose of being published on future marketing flyers/pamphlets, the Camp's website, Facebook, and/or in the Camp's newsletter.YES, I understand ALL Camp BCC Summer Day Camp staff and volunteers are certified mandated reporters. This means the Vermont State Law requires all staff to be trained in detecting signs of child abuse, mistreatment, and/or neglect and upon seeing signs are required by law to report the signs to the Vermont Department of Children and Family Services.
Sunscreen Consent

Camp BCC Summer Day Camp staff may apply "Camp Supplied" sunscreen prior to all outdoor play according to the criteria below.I will supply sunscreen for Camp BCC Summer Day Camp staff to apply to my child as described in the criteria below prior to all outdoor play. I have also labeled my child's sunscreen with their first and last name.NO, Staff may not apply sunscreen to my child. I have provided sunscreen that is labeled with my child's first and last name and they are responsible for applying sunscreen with no help from staff prior to all outdoor play.NO, Staff may not apply sunscreen to my child. My child will NOT have their own sunscreen and will need to be given some from Camp Staff. However, Camp staff may NOT apply the sunscreen my child will be responsible for applying it themselves prior to all outdoor play.
The Camp BCC Summer Day Camp staff, prior to any and all adventures into the outdoors, will dedicate a 15-minute block of time dedicated to sunscreen application. If you have indicated that staff apply sunscreen to your child, supplied by Camp BCC or yourself, they will apply the sunscreen only in the manner that follows.

Spray sunscreen will be applied to all exposed skin, including shoulders, arms, legs, and neck. Lotion sunscreen (aka Zinc) will be applied to your child's face, ears, and nose.
On-Site Movies: Occasionally, on rainy days, an activity may include the showing of a movie. PG movies are rated as (parent guidance suggested). This section gives your permission for you camper to watch a PG rated movie.

I give permission for my child to watch a PG movieI do NOT give permission for my child to watch a PG movie, all movies must be rated G for (general audience)
Upon submitting your camper application, you will receive an email and mailed letter within 2–3 business days confirming your child’s enrollment or placement on the waitlist.

If your child is enrolled, you will receive a welcome letter and packet that includes a what-to-bring checklist, a copy of our rules and policies, and other important camp information. The packet will also include a behavior consent form for you and your camper(s) to review and sign together.

Please bring the completed form with you on the first day of camp and turn it in at the check-in desk.
Should be Empty:

Camp BCC Registration

CAMPER INFORMATION:

Materials Fee

PARENT/GUARDIAN INFORMATION:

Emergency Contact Information

MEDICAL INFORMATION