Polk County Young Life 2024 Weekend Camp

WHERE: Southwind

WHEN: December 13, 2024 - December 15, 2024

Departure: December 13th

Return: December 15th around 2pm

COST: $350, a deposit of $100 is required to hold your spot.

Money is nonrefundable after December 6th

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

Questions and Information

Contact the Young Life Office at:

Pat Fitzgerald - [email protected] or 863-701-9245

Participant Information

Guest Type

Camper [1 remaining]
Leader [5 remaining]

Registration Options

Register with a deposit or full payment ($350.00)
To register with credit card choose this option.
Register with Cash/Check ($350.00)
To register with cash/check choose this option. $100 deposit to reserve your spot.
Admin Fix - Morgan ($350.00)

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

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% 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.

Coupon Code

Participant Information

Parent / Guardian Information

Billing Information