Clone of CHURCH REGISTRATION FORM 2025

Church Registration Form

(To be completed by the Head Counselor)
Church Name*
YesNo
Pastor Name*
Head Counselor*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact E-mail*
example@example.com
Church Phone Number*

Area CodePhone Number
Contact Phone Number*

Area CodePhone Number
Registration Fees for BPYC 2026

Church non-refundable deposit is $100.00
Please note for BPYC 2026

Any damages incurred due to behavior issues will be billed to the participating offending church.

Pre-Registration Totals:*

Rows	Males	Females
Campers
Volunteers
Counselors
Director or Staff (Appointed by BPYC Executive Directors)

Note: Your pre-registration totals can be adjusted later if necessary.
Pre-Registration must be postmarked by 05/25/2025.

Please send all mail in payments to the following address:

Barbourville Pentecostal Youth Camp

Attn: James Carrier

1444 Greenbriar Rd,

Waynesburg, KY 40489
The following information is required to complete your registration:*
Upload Documents:*

Upload Files
You can upload your Church proof of insurance here. Cancelof
Participant's Roster will be coming soon and will need to be completed by the head counselor.
Should be Empty: