Summer 2025 Template

WHERE: Rockbridge

WHEN: August 02, 2025 - August 06, 2025

Departure: {Week Day}, {Enter DATE/TIME} / Late bus {Enter TIME}

Return: {Week Day}, {Enter DATE/TIME}

COST: $735, a deposit of $50 is required to hold your spot.

Money is nonrefundable after {Enter DATE}.

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:

11363 Eagle Run - Lincoln, DE 19960

(302) 632-5065 - [email protected]

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($735.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment/$0 deposit ($735.00)
To register without credit card information, select cash/check/offline. This option will also create a payment link for the full balance listed.

Participant Name

Date of Birth

Participant Phone

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. 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

Total

$0.00

Participant Information

Parent / Guardian Information

Billing Information