2025 Dunes HS Winter Retreat Registration

2025 Dunes HS Winter Retreat Registration

January 17 - 20, 2025
Camper Name (the name you put here will go on their camper name tag)*

First NameLast Name
Birthday*

MonthDayYear
Date
Gender*

MaleFemale
Grade*
Home Church
Parent's Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*

Area CodePhone Number
Other Phone Number

Area CodePhone Number
Email*
example@example.com
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Is anyone, other than the parent listed above authorized to check camper out of camp? *
Please provide specific names and relationship to camper

Medical Information
Insurance Provider Name*
Insurance Provider Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Policy # or ID*
Physician Name

First NameLast Name
Physician's Phone Number*

Area CodePhone Number
Does the camper have any pre-existing medical conditions or food allergies?*

YesNo
Please list conditions and/or food allergies
Dunes offers alternate food options for campers with gluten, dairy, egg, or nut allergies. You are also welcome to send food with your camper to be stored in the camp kitchen.
Are they taking any prescription medications?*

YesNo
Please list medications
Prescription medications need to be in their original container and labeled to include camper’s name, prescribing provider and dosing. Non-prescription medications need to be in original container when brought to the nurse with instructions for use. The nurse has the right to request this information before receiving any medications.
Are immunizations current?*

YesNo
Can your camper receive over-the-counter meds?*

YesNo
Please list any other medical or behavioral conditions Dunes should know about
Dunes is not able to accommodate campers who need 1-on-1 care. Please contact the camp office if you have any questions about whether or not we can host your camper.

Cabin Buddy Request

Please choose cabin mates. They should also choose you. These requests are not guaranteed.
Cabin Buddy Choice #1

First NameLast Name
Cabin Buddy Choice #2

First NameLast Name
Registration Submission

You cannot SUBMIT your registration until you have read and accepted the Parental Release & Permissions - The SUBMIT button will not appear until completed. By submitting, I agree that I am the parent/legal guardian of the child being registered.
PARENTAL RELEASE & AGREEMENT A. The purpose of the Dunes Bible Camp (DBC) is to provide programs and/or a facility to assist Christians in bringing the gospel of Jesus Christ to every camper and to help Christians grow in their faith. B. Any participant that engages is illegal activities, endangers others, or refuses to conform to the camp rules is subject to being sent home immediately. The parents or guardians will be responsible for transportation and will forfeit camp fees. Modesty dress is also required. The camp reserves the right to determine the standard of attire. C. My child has permission to participate in all activities on or off the grounds. I recognize that DBC has taken extensive safety measures, however, I also recognize DBC cannot guarantee that the participants, equipment, grounds, and/or activities will be free of accidents or injuries. I will defend DBC, its staff, employees, volunteers, and its Board of Directors from any claims of liability arising from my/my child's participation in the DBC camps or activities. D. I give permission for DBC to use any photo or video of my child for DBC publications or promotion/advertising. I release my right to any kind of remuneration for said photos or videos. E. In the event that I cannot be reached in an emergency, I give permission to the physician selected by the camp director to hospitalize, secure proper treatment for, and order injection, anesthesia, X-rays, routine tests, and/or surgery; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child. F. I hereby authorize the directors and staff at DBC to act for me in their best judgment in any emergency requiring medical attention. I have made note of any medical or physical problems which might affect my child's ability to safely participate in the camp. Please sign below if you have read and agree to the PARENTAL RELEASE & PERMISSION agreement:*

Yes, I have read and agree to the PARENTAL RELEASE & PERMISSION AGREEMENT
Signature*

Clear
Payment

Campers are not guaranteed a spot until a completed registration form and full payment is received. In case of cancellation, Dunes will retain a $25 administration fee.

Dunes HS Winter Retreat$185.00

Payment Options

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Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

NOTE: Enter your billing zip code in the field "12345"
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