Summer 2025 Template

WHERE: Lake Champion

WHEN: July 15, 2025 - July 20, 2025

Departure: Tuesday, July 15th @ 7:00 AM

Return: Sunday, July 20th @ 10:00 PM

COST: $899.00, a deposit of $150.00 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:

5401 Fallowater Ln, Suite H Roanoke 24018

(540) 808-9784 - [email protected]

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($899.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment ($899.00)
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

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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

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

Parent/Guardian Email

Address is same as participant

Address

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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