Summer 2025 Template

WHERE: Rockbridge

WHEN: July 22, 2025 - July 26, 2025

Departure: Tuesday, July 22nd @ 11:00 AM

Return: Saturday, July 26th @ 2:00 PM

COST: $699.00, 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 full payment ($699.00)
Please select to make a full payment below.
Register with a $150 deposit ($699.00)
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

Adult T-shirt Size

School

High School Graduation Year

Additional Comments

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

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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
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American Express
Discover

Address

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