Camper Information

Participant Name

Date of Birth

Participant Phone

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Phone Type

Participant Email

Participant Address

Gender

Male
Female

Ethnicity

T-Shirt Size

School/Club attending:

Grade:

Young Life Leader name:

Parent/Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

Phone Type

Parent/Guardian Email

Address is same as participant's?

Address

Cost

Total Cost: $250

$250.00

Discount Code

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Other

Credit Card

Visa
Mastercard
American Express
Discover

Address

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