Car Registration Form

Name(Required)

First Last

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Car Make:(Required)

Car Model:(Required)

License Plate Number:(Required)

Please read the wavier below:

Signature (I agree to the wavier above)

Car Registration(Required)

Price: $20.00

** Please Note: Early Registration fee of $20, $25 registration fee day of event.

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.

My son is always happy to go to BARC and is joyful!

My son can’t wait to get there; we love all the people who work. We appreciate the outstanding efforts made by the staff every day.

My daughter is lovingly cared for by staff who are always helpful.

We could not be more pleased with the care and support of the staff.

I absolutely love BARC, my job, my coworkers, and of course the individuals! I believe in the agency and its mission. BARC is the best agency I have ever had the privilege to work for.

I am very pleased with the program; staff are very professional and courteous. They are knowledgeable and answer all questions extremely well.