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, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. 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