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Fall Retreat Registration

Register here for Brook Cherith Camp's 2009 Fall Retreat! October 2-4 we will be packing the camp with kids and having all the joys of camp in a weekend!! Join us for this awesome event you won't want to miss. Only ONE REGISTRATION FORM PER CAMPER please.

Parent/Guardian's Name * Title First Last Suffix
Camper's Name * First Last
Gender *
Male Female
Camper's Birthday * MM / DD / YYYY
Grade in Fall (number) *
Enter a number between 3 and 12.
Camper's Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Camper's Email
Parent/Guardian's Email *
Home/Mobile Phone * ### - ### - ####
Work Phone Number ### - ### - ####
Alternate Contact Person * Title First Last Suffix
Alternate Contact's Phone Number * ### - ### - ####
Have you attended BCC previously? *
Yes No
I would like to register for *
BCC Fall Retreat - $50 (October 2-4, 2009)
In providing an electronic signature below, I hereby certify that this information is accurate, and I give my permission for the use of photographs and videos including my child to be used in camp publications; for my child to be transported in camp approved vehicles to and from off-campus activities; for the release of medical records in case of an illness or injury; and for the camper named herein to engage in all activities, except noted by me/ or attending physician. I also give my permission to the doctor selected by Brook Cherith Camp Inc. to order or perform routine and emergency medical treatment for the camper named herein. I also give my permission to the Brook Cherith Camp Health Officer to give routine, nonsurgical treatment when needed.
Parent/Guardian Initials *
Must be between 2 and 3 characters. Currently Used: 0 characters.
Date * MM / DD / YYYY
By clicking Register below you will be redirected to PayPal to fulfill payment for the fall retreat by Credit Card. You do not have to have an account with PayPal to fulfill this order.

If you would like to make your payment by check please click Register below and simply close the PayPal screen (you will still be registered for the event and receive a confirmation email). Please mail your completed check for $50 per camper to Brook Cherith Camp 10 days prior to the event (If you are registering after Sept. 23rd then please bring the check with you to camp) . If you have any questions please call us at 231.937.5305.

Brook Cherith Camp
4050 West County Line Rd
Pierson, MI 49339
Payment options *
Pay online now Pay by check

If paying by check, please mail your check to the address above at least 10 days prior to retreat weekend.
OR
If you are registering after Sept. 23 please bring your payment with you to camp.
Do Not Fill This Out

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