WHERE: Washington Family Ranch Creekside

WHEN: Friday, May 24 - Monday, May 27th (Memorial Day Weekend)

DEPARTURE/RETURN: morning of the 24th and return late on the 27th (it's a four-day weekend)

COST: $325, a deposit of $100 is required to hold your spot.

Deposits are non-refundable after April 1st

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

Questions and Information: Contact your Young Life Leader

Participant Information

Guest Type

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Ethnicity

T-shirt Size

Current School and Grade (during the 2023-2024 year)

if "other", please specify school & graduation year

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

Phone Type

Parent/Guardian Email

Address is same as participant*

Address

Registration

Registration Options

Capernaum Camper Using DDA
Please select to use DDA, connect with Bria to complete form.
Register with a deposit ($100) or full payment ($325)
Please select to make a deposit or full payment below.
Register without a deposit
requesting scholarship or making an offline payment
I am a Young Life Leader

It is a bad assumption that everyone can afford the cost of camp. This is the place to let us know if paying the deposit or full payment is not doable this year. If your child needs help fundraising via work projects, or you would like to request a scholarship, please let us know. We cannot guarantee that we will be able to help everyone but we can guarantee that we will make an attempt. Also, if you'd like to help others by providing scholarship funds, please let us know that here as well.

Payment Notes

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.

Total

$0.00

Billing Information

Name

Payment Method

Credit Card
Cash/Check/DDA

Credit Card

Visa
Mastercard
American Express
Discover

Address

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