Summer 2025 Template

WHERE: Rockbridge

WHEN: July 17, 2025 - July 21, 2025

Departure: July 17, 11:30 a.m.

Return: July 21, 3:00 p.m.

COST: $TBD, a deposit of $50 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

Registration Options

Register with a deposit or full payment ($700.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment/$0 deposit ($700.00)
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

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. 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

Parent / Guardian Information

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

Address

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

Total

$0.00

Participant Information

Parent / Guardian Information

Billing Information