Summer 2025 Template

WHERE: Lake Champion (247 Mohican Lake Rd, Glen Spey, NY 12737)

WHEN: June 21-26, 2025

Departure: Saturday, June 21 @ 7:00am

Return: Thursday, June 26 @ 6:00pm

COST:

❌ Christmas Price: $875 (now through December 31st)
❌ Early Bird: $925 (through March 1st)
✅ Regular Price: $975 (after March 1st)

A deposit of $150 is required to hold your spot. Money is nonrefundable after March 1, 2025.

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

Questions and Information

Mark Cruz [email protected] (Ashburn)

Katie Hiemstra [email protected] (Brambleton)

Visit our website: greaterashburn.younglife.org

Visit Lake Champion's website: lakechampion.younglife.org

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($975.00)
Please select to make a deposit or full payment below. This will be paid by credit card.

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.

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

Please note any special circumstances (need to leave camp early, received a camp scholarship, need information about fundraising, etc.).

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 round up $25 and help students who need financial assistance?

Would you like to cover the 2.5% credit card processing fee?

Credit Card Fee

$0.00

Total

$0.00

Coupon Code

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

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