Summer 2025 Template

WHERE: Rockbridge, 170 Spring House Rd, Goshen VA (540) 997-9276

WHEN: July 10-15, 2025

Departure: Early morning on Thursday, July 10th

Return: Evening on Tuesday, July 15th

COST: $799, a deposit of $50 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 Area Director Clint Falduto at [email protected] & (304) 281-7820 or YL leader Lucas Thorpe at [email protected] & (443) 521-7085

Offline payments can be mailed to: Dorchester County Young Life, PO Box 1243, Cambridge MD 21613

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($799.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment/$0 deposit ($799.00)
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

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

Would you like to cover the 2.5% credit card processing fee?

Total

$0.00

Participant Information

Parent / Guardian Information

Billing Information