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

 
Student's Last Name: *

 
Date of Birth: *

 
Address:

 
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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