Summer 2025 YoungLives Template

WHERE: Rockbridge- A Young Life Camp at Goshen, VA

WHEN: July 06, 2025 - July 09, 2025

COST: Early bird special if registered before March 1st, $399 with $100 deposit.

Regular pricing after March 1st: $649

Money is nonrefundable after June 15th, 2025.

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:

PO Box 803 Culpeper, VA 22701

540-604-3282 - [email protected]

Participant Information

Guest Type

Are you bringing a child?

Registration Options

Register with a deposit or full payment ($399.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment ($399.00)
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