BCSC - Online Registration

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Online Registration

When registering online your information will be sent electronically to the Sailing Center Registrar.

On-line registration will NOT ensure placement in the camp session until we receive payment.

Two ways to pay:

Check the box at the bottom of the form to receive an e-mail bill to pay on-line
Make your check payable to Back River Recreation Council or BRNRC and send it to the following address.

BCSC Registrar
P.O. Box 34134
Essex, MD 21221-8134

Registration Form
PLEASE FILL OUT A SEPARATE FORM FOR EACH PARTICIPANT AND PROGRAM!

Program and Session Desired (select one)
All Programs:

Participant Information
First Name
Last Name
Phone
Street Address
City
State
Zip
email
	Please Note: An email address is required to process your online registration.
School Attended (if applicable)

Where did you here about us?
If refered by a Friend, Name:
Promotion Code (brochure back)

Complete this section if participant is under 18 years of age
Participant's Date of Birth
Parent 1 First Name
Parent 1 Last Name
Parent 1 Day Phone
Parent 2 First Name
Parent 2 Last Name
Parent 2 Day Phone
If parents can not be reached, please give information of a person to notify in case of emergency
Name
Relationship
Day Phone
Camp Bus Service Desired	Yes	No	Available for two-week camps only
If yes, Which stop
If bus service is used, it is the parents responsibility to deliver or pick up the participant at the appointed time and place. The bus driver can not wait and the Baltimore County Sailing Center, the Bus Driver and Bus Company are absolved of any and all responsibility.
Summer Camp Participants must have a current immunization record on file before attending camp.

All must read and complete this section
Are there any medical or other health factors that might affect you / your child's performance in this activity?
	Yes	No
Are you / your child taking any medications that might affect your / your child's performance in this activity?
	Yes	No
Are there any medical or other health related problems which we should be aware of?
	Yes	No
Does the participant have a disability which requires an accommodation?
	Yes	No
Please explain any "YES" answers to the above questions in detail:

Physician's Information
Doctor's Name
Doctor's Phone Number
Date of last Tetanus Shot
Insurance Carrier
Policy Number

We can now accept your payment with a credit card. If you would like us to e-mail a bill which you can pay on-line, please indicate below.
Request e-mail bill:

By registering online, you understand that the Sailing Center is not responsible for lost electronic registrations and in no way guarantees flawless electronic transfers.

This page was last updated on May 20, 2008