Capernaum Rockbridge Trip, Aug. 1-5
This form is only to be filled out by parents, guardians or students over 18 years of age. Thank you for signing your child up for the best week of his/her life!  

Camp Info:
Rockbridge, August 1-5, 2020
Cost: $550
Scholarships: Ask Jeff or Scott for info

Three easy steps to sign up:

1.  Fill out the form below.

2.  Get your $100.00 deposit (Checks to Young Life) to Lindsay or Jeff (Salem Young Life, PO Box 546, Salem, VA 24153)

3. After submission, check your email for a link to fill out the online health form.  YL is offering a $30 Early Signup Incentive for filling out your health form NOW.  Please follow the directions in the email and fill out the form to get your discount.  This discount is for a LIMITED time and is given on a first come, first serve basis.  YL Salem/Glenvar cannot guarantee this discount if your health form is not filled out within 24 hours of the camp signup night.

If you have questions, contact Lindsay at 636-667-8665 or Jeff at 540-353-2026
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Parents First Name *
Parents Last Name *
Address *
(street, city, zip)
Camper's First Name *
Campers Last Name *
Parent/Guardian email *
Parent/Guardian Cell Number *
Number of times your child has been to Capernaum camp? *
Second time policy: Students between the ages of 13-22 are allowed to attend Capernaum camp 2x.  After the second year they will be asked to let first time people go before them and then if there is room we will add them to the trip.  Our heart is to take every kid but unfortunately there are limited spots available.  
Are you a camper or buddy? *
Shirt Size *
"Adult sizes"
Camp Agreement/Drop Date *
I understand that Salem/Glenvar/Northside YL is under contract with the camp to pay for this camp spot after April 1st.  You may drop and get refunds before March 31st without penalty.  If your child drops out after March 31st, you are accepting the financial responsibility for that spot regardless of the reason.                                                                                                                                                                                                                                           Exceptions:                                                                                                                                                                                                                1.  We find a replacement camper (not currently signed up and willing to pay full price).                                                                      2. There is someone from a waiting list (that is willing to pay full price) that will take his/her spot.                                                         3. Salem Young Life is able to give your spot to another YL Area (highly unlikely).        
Camp Agreement/Fundraiser Refunds *
I agree that all money raised through Young Life fundraisers is non-refundable.  If your child drops out of camp, all fundraiser money will be put into a general camp scholarship fund.
Camp Agreement *
I agree that Salem Young Life will offer at least one fundraiser for my child to participate in.  I understand that participation in these fundraisers is optional and is up to the parents and the camper to participate.  YL staff and leaders will help but the responsibility rests on each camper to make the most of the fundraiser(s) offered.  Salem Young Life does not guarantee an amount that can be raised through fundraisers.  Each parent and child is responsible to pay for camp regardless of fundraisers.
Camp Agreement/Esignature *
Please give your name and phone number in the space below as your signature agreeing to all of the above.  
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