RESIDENT APPLICATION

Fill out and submit the resident application below as best you can and we will be in contact with you shortly. 

GENERAL INFORMATION

Enter your first name

Enter your dob.

Enter a secondary phone number

Enter your last name

Enter your primary phone number

SUBSTANCE INFORMATION

YesNo

BCRC is not a medical facility, therefore every resident must be successfully detoxed before admission to the program. Every prospective resident is asked to submit to a drug and alcohol test immediately prior to their admission

YesNo

HEALTH INFORMATION

YesNo

YesNo

YesNo

YesNo

BCRC is not a medical facility and does not employ a medical staff. This means that you may not be accepted as a resident if you are not healthy enough to participate in all aspects of the program or require regular doctor visits.

EDUCATION INFORMATION

LEGAL INFORMATION

YesNo

YesNo

BCRC program residents participate in fundraiser trips that are sometimes outside of NC. This means that you may not be accepted if you cannot leave the state.

YesNo

YesNo

NoYes

Due to BCRC's zoning, we are unable to accept convicted sexual offenders

YesNo

YesNo

FAMILY INFORMATION

YesNo

YesNo

Residents of BCRC do not have an income during the 90-day program. This means that arrangements must be made for any financial obligation prior to admittance

ADDITIONAL COMMENTS

E-MAIL

bcrc@atmc.net

PHONE

(910) 287 4357