Summer 2025 Template

WHERE: Rockbridge

WHEN: June 03, 2025 - June 08, 2025

Departure: Monday, June 2nd at 10pm

Return: Monday, June 9th at 1:30pm (arrive home at 1:30am)

COST: $1150 a deposit of $150 is required to hold your spot.

Money is nonrefundable after January 15, 2025.

After completing this form, a confirmation will be sent with the information you have entered below.

Questions and Information

Contact at the Young Life Office at:

[email protected]

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($1,150.00)
Please select to make a deposit or full payment below. This will be paid by credit card.

Participant Name

Date of Birth

Participant Phone

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Phone Type

Participant Email

Opt-in to receive email and text message communications.

You agree to Young Life's terms and privacy policy. Msg & Data rates may apply.

Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

T-shirt Size

School

High School Graduation Year

Additional Comments

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

Phone Type

Parent/Guardian Email

Address is same as participant

Address

Would you like to cover the 2.5% credit card processing fee?

By selecting "yes" to the credit card processing fee will, a one time 2.5% for the whole cost of camp will be charged to your credit card. Even if you are only paying the deposit today, the 2.5% fee will be charged for the whole cost of camp.

Total

$0.00

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

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