Summer 2025 YoungLives Template

WHERE: Rockbridge Alum Springs - 170 Spring House Rd. Goshen, VA 24439

WHEN: July 6, 2025- July 9, 2025

Departure: Sunday, July 6 at 7am (3901 Gallows Rd. Annandale)

Return: Wednesday, July 9 at 5pm (3901 Gallows Rd. Annandale)

COST: $ 575 and a deposit of $ 50 is required to hold your spot.

Money is nonrefundable after 6/15/25

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:

Esther Horner

[email protected]

804-539-6165

PO BOX 5682

Springfield VA 22150

Participant Information

Guest Type

Are you bringing a child?

Registration Options

Register with a deposit ($50) or full payment ($575.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment ($575.00)
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

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 Address

Gender

Male
Female

Ethnicity

Other Languages Spoken

T-shirt Size

High School Graduation Year

Additional Comments

Parent / Guardian Information

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

Parent/Guardian Name

Parent/Guardian Phone

Phone Type

Parent/Guardian Email

Address is same as participant

Parent/Guardian Address

Total

$0.00

By filling out this form, you are opting in to Young Life communications.
In the future, you will be given the opportunity to manage your communication preferences.

Participant Information

Parent / Guardian Information

Billing Information