Summer 2025 Template

WHERE: Southwind Young Life Camp

WHEN: June 08, 2025 - June 12, 2025

COST: $775 , a deposit of $125 is required to hold your spot.
Finances should never keep a kid from experiencing Wyldlife camp. In this case, a camper & their parent/guardian can fill out our Scholarship Application Form.

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

With questions contact:
Young Life Jax Beaches
Payton Harris | [email protected] | 904.451.1307

Participant Information

Guest Type

Registration Options

Register with a deposit ($125) or full payment ($775.00)
Please select to make a deposit or full payment below. This will be paid by credit card.

Participant Name

Date of Birth

Participant Phone

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Participant Email

Opt-in to receive email and text message communications.

You agree to Young Life's terms and privacy policy. Msg & Data rates may apply.

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

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

Coupon Code

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

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