2024 Rockbridge Week 8

WHERE: Rockbridge Alum Springs

WHEN: July 13, 2024 - July 17, 2024

COST: $650, a deposit of $100 is required to hold your spot.

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:

PO Box 300, Blacksburg 24063

(540) 418-6287 - [email protected]

Participant Information

Guest Type

Are you bringing a child?

Registration Options

Register with a deposit or full payment ($650.00)
Please select to make a deposit or full payment below. Your card will not be immediately charged.
Register with an offline payment or without a deposit ($650.00)
Please select to register without a deposit or to make an offline payment by sending cash/check to the YL office directly.

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Ethnicity

Other Languages Spoken

T-shirt Size

High School Graduation Year

Parent / Guardian Information

Fill out the following parent/guardian information for the participant you are registering above.

Parent/Guardian Name

Parent/Guardian Phone

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

Phone Type

Parent/Guardian Email

Address is same as participant

Parent/Guardian Address

Billing Information

Name

Payment Method

Credit Card
Cash/Check

Credit Card

Visa
Mastercard
American Express
Discover

Address

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