Summer 2025 Template

WHERE: Rockbridge Alum Springs

WHEN: June 09, 2025 - June 14, 2025

Departure: Monday, June 9th

Return: Saturday, June 14th

COST: $750, a deposit of $100 is required to hold your spot.

Money is nonrefundable.

After completing this form, a confirmation will be sent with the information you have entered below.

Questions and Information

Contact our Young Life Area Director, Ray Wileczek at:

(610) 883-2847

younglifelouisava@gmail.com

Participant Information

Guest Type

Registration Options

Participant Name

Date of Birth

Participant 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 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

Additional Comments

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

Phone Type

Parent/Guardian Email

Address is same as participant

Address

Total

$0.00

Participant Information

Parent / Guardian Information

Billing Information