Summer 2025 Template

WHERE/DONDE: 170 Spring House Rd, Goshen, VA 24439

WHEN/CUANDO: 06/22/2025 -06/27/2025

Departure: Sunday June 22nd, at 8:30am from 4530 N 5th St

Return: Friday June 27th, at 6:30 to 4530 N 5th St

COST: $300 deposit of $50 is required to hold your spot. *Registrations with deposit before 01/15/2025 will receive a $100 discount off the total.

Money is nonrefundable after 06/01/2025

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

Costo: Se requiere un depósito de $300 o $50 para reservar su lugar. *Las inscripciones con depósito antes del 15/01/2025 recibirán un descuento de $100 sobre el total.

El dinero no es reembolsable después del 01/06/2025.

Después de completar este formulario, se enviará una confirmación con la información que ha ingresado a continuación.

Questions, Preguntas, y Information

Contact the Young Life Trip leader at:

Kylie Hatfield, Area Director 267 626-3539 or [email protected]

Luz Alva, Olney Team Leader 321 265-0015 or [email protected]

Jose Ferran, Esperanza Team Leader 267 788-9968 or [email protected]

Participant Information

Guest Type

Registration Options

Register with a full payment ($300.00)
Please select to make a full payment below. This will be paid by credit card.
Register with a $50 deposit ($50.00)
Please select to make a deposit. This will be paid by credit card.
Register with Offline Payment ($0.00)
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. 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

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

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