High School Summer Camp
August 4-7, 2017
Dunes Bible Camp
23515 Pacific Way
Ocean Park, WA 98640
Student's First Name: *

Student's Last Name: *

Date of Birth: *


Street: *

City: *

State: *

ZIP Code: *

Student Cell Phone:

Student Email:

Grade *

Incoming for Fall 2017

School: *

Parent/Guardian First Name: *

Parent/Guardian Last Name: *

Parent/Guardian Cell Phone: *

Parent/Guardian Email: *

t-shirt size: *

For sizing, keep in mind that the shirt style is unisex.

Medical/Allergy Information & Dietary Restrictions.

I would like to room with:

We'll do our best to honor roommate requests, but will not guarantee them.
Retreat Payment.

Please enter your Credit or Debit Card number:

The CVC number:

(3 or 4 digit security number on the back of your card)
The name on your card:

Your card's expiry month:

Your card's expiry year:

Thank you for registering for High School Summer Camp!
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