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2019 YL Capernaum Camp: Rockbridge $675
Please fill out this form completely to register for the 2019 YL Capernaum summer trip to Rockbridge! A $100 deposit is required in order to complete your registration. You may pay for the trip using a credit card, debit card, or online transfer at

*We would prefer for you to make your payment online. But you may turn in a check to your Capernaum leader at Capernaum Club on the first Tuesday of every month or mail a check made out to "Carroll County Young Life" to the Carroll County Young Life office (55 Ridge Rd / Westminster, MD 21157).

*Each camper MUST fill out a Health Form, which can be completed entirely online at
Every section of the Health Form MUST be filled out, including the section on "Immunizations". A physician's signature is NOT required for our trip.

*In addition, a parent or guardian must complete the Capernaum Parent-Guardian Form, which must be downloaded from and handed in to a Capernaum leader.

First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City, State, Zip *
*Please include ALL!
Your answer
Gender *
School *
Age of Capernaum Camper as of 8/14/19 *
*Camper must be between ages of 14 and 22 during camp week
Your answer
Camper Cell Phone
Your answer
Parent/Guardian First and Last Name *
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Cell Phone # or Home Phone # *
Your answer
Adult T-Shirt Size *
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