Young Life Camp

WHERE: Rockbridge Alum Springs

WHEN: December 06, 2024 - December 08, 2024

Departure: Friday, December 6 @ 4pm

Return: Sunday, December 8 @ 4pm

COST: $150, a deposit of $ 50 is required to hold your spot.

Money is nonrefundable after November 30

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:

Eastern Fairfax Young Life

PO Box 5862 Springfield, VA 22150

Bella Rivas:

540-840-3219

[email protected]

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($150.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment/$0 Deposit ($150.00)
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

Phone Type

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, 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% processing fee?

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.

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

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