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Student Life at the Beach
High School Summer Camp
July 7-11, 2008
Daytona Beach, FL
Deposit of $50.00 Due ASAP
Limited Space Available!!
Cost: $350.00 Due By June 1, 2008

Name:
Address:
City:     State:    
Zip Code:
 Phone:    Email:

Grade:       Gender:

Parent/ Guardian Information

Name:
Home Phone: Other Phone:

 

*Click here to download the waiver and release form - When completed return completed and signed form to The Grace Place by:

1. Mail form to 1550 S.E. Salerno Road Stuart, Fl. 34997 Attn: James Pendleton

2. Return form to The Grace Place main office Mon - Fri from 8 am - 5 pm Attn: James Pendleton

3. Send the completed form with your student to youth group

Click below to Submit your registration and pay. You will be directed to an online payment page. Please put "Student Life at The Beach" in the designation box.