2024 Lost Canyon Wk 4

WHERE: Lost Canyon

WHEN: June 23, 2024 - June 28, 2024

Departure: Sunday, June 23rd 5AM

Return: Friday, June 28th 11PM

COST: $600, a deposit of $50 is required to hold your spot. Fundraising opportunities available this spring! Sign up by January 1st and receive $100 off!

Money is nonrefundable after June 16th.

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

Questions and Information

Contact at the Young Life Office:

Breanna Flores 559-991-2981

[email protected]

Participant Information

Guest Type

Are you bringing a child?

Registration Options

Register with a deposit or full payment ($600.00)
Please select to make a deposit or full payment below. Your card will not be immediately charged. Fundraising opportunities available this spring! Sign up by January 1st and receive $100 off!
Register without a deposit ($600.00)

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Ethnicity

Other Languages Spoken

T-shirt Size

High School Graduation Year

Additional Comments

Parent / Guardian Information

Fill out the following parent/guardian information for the participant you are registering above.

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

Parent/Guardian Address

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

Total

$0.00

Billing Information

Name

Payment Method

Credit Card
Cash/Check

Credit Card

Visa
Mastercard
American Express
Discover

Address

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