Student Information/Registration Form

Student Information/Registration Form
All BMCU students must complete this form prior to August 1st for the fall semester. Failure to complete registration by the deadline could result in a $250 late fee.

This form contains multiple pages that include student health information, vehicle registration, and registration information/computer use agreement. Please complete each page and hit 'submit' at the end. Exiting the form before submission may lose all progress. A confirmation email will be sent after submission.
Name*

First NameLast Name
Maiden Name (if applicable)
BMCU Email*
firstlastname@bmc.edu
Secondary Email*
Please use a personal email address or a parent's email.
Student Cell Number*

Country Code (1 for U.S.)Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County*
Date of Birth*

MonthDayYear
Date
Student ID
If you don't know your BMCU Student ID, leave blank.
Click 'Next' to continue. Exiting may lose your progress.

Student Health Information
Emergency Contact Name*
Emergency Contact Phone Number*

Country Code (1 for U.S.)Area CodePhone Number
Second Emergency Contact Name (optional)
Second Emergency Contact Number (optional)

Country Code (1 for U.S.)Area CodePhone Number
Are you allergic to anything? (food, medication, etc.)*

YesNo
Please list all known allergies.*
Do you take any medications regularly?*

YesNo
List any medications you currently take. *
Are there any medical issues that we need to be aware of? (optional)
Waiver of Consent to Release of Health Information
I understand that the health information provided above may be disclosed to necessary parties such as in cases of emergency.*

I understand.
Click 'Next' to continue. Exiting may lose your progress.

Registration Information/Computer Use Agreement
Month and Year of Expected Degree Completion*
Example: May 2028
Degree*
Denominational Preference*
Name of Church of which you are a member*
If none, enter N/A.
City and State where Church is located*
Name of Pastor*
Type name.
Are you presently serving on a church staff?*

YesNo
Have you accepted a call (full-time or part-time) to a church-related vocation?*

YesNo
Computer Use Agreement
All students who use campus-owned computers are required to read the following statement related to acceptable computer use:

BLUE MOUNTAIN CHRISTIAN UNIVERSITY ACKNOWLEDGEMENT AND AGREEMENT

I will read Blue Mountain Christian University's Acceptable Computer Use Policy and agree to its requirements, as periodically amended. (Policy 2.22)
I have read and agree to the above statement.*

I agree.
By signing in the box below, I warrant that all information provided is true, complete, and accurate.*
Click 'Submit' to finish the form. You will be redirected to a confirmation page once your submission is complete. A copy of your answers will be sent to the email address provided.
Should be Empty:

Student Health Information