Summer 2025 Template

Participant Information

Guest Type

Scholarship Form Request

Registration Options

Register with a deposit or full payment with Credit Card. ($695.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with an offline payment ($695.00)
Select cash/check/offline payment to pay with cash or check, which will need to be paid to the Young Life office.

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.

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

Dietary needs

Additional Comment

Ethnicity

T-shirt Size

Young Life Club

Current Grade

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