Summer 2025 Template

WHERE: Lake Champion 247 Mohican Lake Road, Glen Spey, NY

WHEN: July 15, 2025 - July 20, 2025

Departure: TBD

Return: TBD

COST: $ 250, a deposit of $25 is required to hold your spot.

Money is nonrefundable after July 15, 2025

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

Questions and Information

Contact at the Young Life Staff:

Tameika Kennie Cell 914-281-1524 & [email protected]

Participant Information

Guest Type

Registration Options

Participant Name

Date of Birth

Participant Phone

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Participant Address

Gender

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Additional Comment

Ethnicity

T-shirt Size

School

High School Graduation Year

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

Participant Information

Parent / Guardian Information

Billing Information