Blue Ridge Gospel Tabernacle
445 Blue Ridge Court
Rocky Mount, VA 24151

Telephone:        1 (540) 483 - 7977
FAX:                 1 (540) 484 - 1466

BRYC Camper Registration

* Students under 18 must include a parents signature at bottom.


Visitor's Guidelines:

- Guys and girls cannot be alone OR in each other's dorms.
- No inappropriate sexual behavior.
- Do not listen to secular music or watch movies.
- No drug, cigarette, or alcohol use.
- No pornographic movies or images.
- No abuse of buildings or school property.
- No foul language.
- Do not leave campus without permission.
- Leave common areas 30 min before curfew & stay in dorms until breakfast.
- Attend all scheduled events. (see BRYC schedule)
- Respect all Blue Ridge Youth Camp staff and leadership.

**NOTICE: By submitting this registration form you affirm that the above information on your form is correct and agree to the following terms and conditions:

I AGREE TO hold harmless Blue Ridge Chapel, Inc., Blue Ridge Youth Camp and/or its subsidiary ministries and leaders for any damages, losses or injuries that I may incur as a result of my participation on campus activities or field trips. I agree to follow all rules and regulations expected of me both written and verbal. I acknowledge that I have read the BRYC guidelines and agree to conduct myself in a way that brings honor to the name of Jesus, myself, the college and my home church both on and off campus while I am attending BRYC. I will not allow myself or encourage others to become involved in any activities during my visit that would be a breach of the visitor guidelines or put myself and/or others in harm's way. I agree to arrive on-time and participate fully in all camp activities with a cheerful attitude. I understand that any breach of these terms and conditions can result in my immediate dismissal from Blue Ridge Youth Camp.

IF UNDER 18, parent or legal guardian's name is required.

(Please fill out this Medical Information)

I grant permission to Blue Ridge Youth Camp to administer general first aid treatment to myself for any minor injuries and illnesses. I also grant BRYC, in the case of servere illness or injury, to summon any and all professional emergency personel to attend, transport, and administer medical diagnosis, treatment or hospitalization to myself if deemed necessary by a medical professional. I am also aware that any medical expenses are of my own responibility and will not hold Blue Ridge Chapel, inc. or its subsidiary ministries, employees, or volunteers responsible for medical expenses I may incur.

IF UNDER 18, parent or legal guardian's name is required.


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