Summer 2025 Template

WHERE: Rockbridge Alum Springs (170 Spring House Rd, Goshen, VA 24439)

WHEN: July 22-26, 2025

Departure: Tuesday, July 22 @ 9:00am

Return: Saturday, July 26 @ 4:30pm

COST: $699. 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

Contact Katie Hiemstra:
[email protected]
(703) 474-4479

Visit our website: greaterashburn.younglife.org

Visit Rockbridge's website: rockbridge.younglife.org

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($699.00)
Please select to make a deposit or full payment below. This will be paid by credit card.

Participant Name

Date of Birth

Participant Phone

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Participant Email

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Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

T-shirt Size

School

Current Grade

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 cover the 2.5% credit card processing fee?

Total

$0.00

Coupon Code

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
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American Express
Discover

Address

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