Summer 2025 Template

WHERE: Rockbridge

WHEN: August 02, 2025 - August 06, 2025

COST: $685

Money is nonrefundable after April 1st.

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:

540-705-1547

[email protected]

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($685.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment/$0 deposit ($685.00)
To register without credit card information, select cash/check/offline.

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?

Total

$0.00

Participant Information

Parent / Guardian Information

Billing Information