2027 Dunes CYA Retreat Registration

Dunes CYA Retreat Registration

December 30, 2026 - January 1, 2027
Name

First NameLast Name
Birthday

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender
Marital Status
If possible, would you like a private cabin for you and your spouse?
Home Church
Mailing Address

Street Address

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number

Medical Information
Any pre-existing medical conditions or food allergies?
Please list conditions / allergies

Registration Submission

You cannot SUBMIT your registration until you have read and accepted the Release & Permissions - The SUBMIT button will not appear until completed.
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 and will forfeit camp fees. Modesty dress is also required. The camp reserves the right to determine the standard of attire. C. 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 participation in the DBC camps or activities. D. I give permission for DBC to use any photo or video of myself 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. 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 ability to safely participate in the camp. Please sign below if you have read and agree to the RELEASE & PERMISSION agreement:
Signature

PAYMENT

Dunes CYA Retreat$135.00

Payment Options

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Expiration Month	Expiration Year

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