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BMC Registration

BMC Registration

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Yes, sign up my daughter for the BMC experience! 

PERSONAL INFORMATION

GIRL'S NAME:   BIRTHDATE (mm/dd/yy):

PARENTS' NAMES: 

SCHOOL ATTENDING: GRADE ENTERING:

HOME ADDRESS:  

PRIMARY PARENTS' EMAIL(S): 

HOME PHONE:    MOTHER'S CELL:

DOES YOUR DAUGHTER HAVE ANY ALLERGIES OR MEDICAL CONDITIONS?     Yes          No 

IF YES, PLEASE SPECIFY: 

EMERGENCY INFORMATION 

EMERGENCY CONTACT: 

PHONE:   RELATIONSHIP:

PAYMENT 

COST:  $225 Annual membership  

 Visa    MasterCard    American Express

Credit Card Number:  Exp. Date (mm/yy):

Billing Zip Code:   

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