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
Birth Date*

MonthDayYear
Session/Day Selection*
Which tuition rate applies to your family?

Minimum rate($200/week)Basic rate ($345/week)Hero rate ($450/week)
Tuition rates

Camp BCC is a summer day camp that offers registration by the day/week/entire session. Each camper can sign up for 1 day, 1 week, or all 4 weeks. if you are signing your camper up for less than 1 week please note that the daily tuition costs are as follows. Minimum: $40/day. Basic: $69/Day. Hero: $90/day.
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
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
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 forms here or check the box below

Cancelof
Check the box below if you will NOT be submitting your campers' immunization records in this application but will be forwarding or snail-mailing them 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 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 your submission of this camper application, we will reach out via email with a behavior consent form for you and your camper(s) to review, agree to, and sign. We will need this form to be brought in on the first day of camp at the check-in desk. If you do not have a printer or way of completing the form digitally we will have blank copies ready for you and your camper to review before they start their first day at Camp BCC Summer Day Camp. We do require this form to be completed before the child can attend Camp unsupervised.
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Camp BCC Registration

CAMPER INFORMATION:

Tuition rates

PARENT/GUARDIAN INFORMATION:

Emergency Contact Information

MEDICAL INFORMATION