Young Life College Weekend Camp!

WHERE: Southwind

WHEN: October 23rd - 25th

COST: $100 & a deposit of $50 is required to hold your spot.

Money is nonrefundable after October 17th!

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

We do not want money to be the reason that anyone can't come!! If you are in need of financial assistance, please fill out this application for camp scholarships.

Questions and Information:

Contact Noah Satterfield - (937) 594-3540

Participant Information

Guest Type

Registration Options

Participant Name

Date of Birth

Phone

Phone Type

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

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Phone Type

Parent/Guardian Email

Address is same as participant

Address

Would you like to cover the 2.5% processing fee?

Total

$0.00

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.

Billing Information

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Name

Payment Method

Credit Card
Cash/Check/Offline

Credit CardSecure Payment

Address

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