Summer 2025 Template

Participant Information

Guest Type

Summer 2025

Clearwater Cove

Registration Options

Register with a deposit or full payment ($1,100.00)
Please select to make a deposit or full payment below. This will be paid by credit card.

Participant Name

Date of Birth

Participant Phone

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Phone Type

Opt-in to receive email and text message communications.

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Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

T-shirt Size (Adult)

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

WHERE: Clearwater Cove, MO

WHEN: July 2, 2024 - July 6, 2024

Departure: July 2, 2024/ Time : TBA

Return: July 6, 2024/ Time : TBA

COST: $1,100, a deposit of $150 is required to hold your spot.

FUNDRAISING : Our camp fundraisers are offered to ALL students. We will be doing a Bingo Board fundraiser, a mulch fundraiser and our annual Car Wash. These are great options if you want your child to personally contribute! Here is our fundraising form to fill out - Link

SPOTS : All first come, first serve! Please sign up even if you’re on the waitlist (waitlisted students have all gotten in eventually the last few years!).

Questions and Information

Contact at the Riverside-Brookfield Young Life Office at:

Natasha Brniak - 773.680.3773 or [email protected]

Ronaldo Mondragon - 708.983.5531 or [email protected]

Participant Information

Parent / Guardian Information

Billing Information