YL Fall Weekend 2017 Registration
Use this form to sign up for our Young Life trip to Saranac Village in November 2017!


November 10th-12th!!
Departure and Arrival details to come :)


You may pay for the trip using a credit card, debit card or electronic transfer. Follow instructions towards bottom of page to place a deposit/payment.

You may also send a check, made out to YOUNG LIFE, to:
PO Box 146
Marcellus, NY 13018

There is no need for a health from for this weekend, but EACH STUDENT MUST fill out a CONSENT FORM found here: https://drive.google.com/file/d/0B0eZZ5Eco_Wiak5BNFZlU1VQM3draC1rSDB5SzN6MEMxNjFn/view

If you have any questions, please call or email Patrick Flint @ (401) 447-6481 or patrick.d.flint@gmail.com

Camper Information
First Name *
Your answer
Last Name *
Your answer
Street Address *
Where you receive your mail
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Gender *
Grade *
Camper Cell Phone Number
Your answer
Dietary Restrictions
Do you have any medical dietary restrictions?
Your answer
Parent Information
Parents first and last names *
"John and Judy Smith" or "John Smith and Judy James"
Your answer
Who will be the contact person for this camper? *
Your answer
Contact parent cell phone number *
Your answer
Contact parent home phone number *
If it is the same, please put same
Your answer
Contact parent email *
The mail email that your family reads and uses
Your answer
Additional email
If necessary
Your answer
Payment Information
Regular Registration $165

Checks can be mailed to address at top of page,
payment for camp can be made by following this link:


Did you make an online payment? *
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