Wichita Capernaum Outreach Camp

WHERE: Clearwater Cove

WHEN: January 18, 2025 - January 20, 2025

COST: $ 225

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

Questions and Information

Contact Lori at the Young Life Office at:

[email protected] or 316-303-1490

Participant Information

Registration Options

Student Registration ($225.00)
Leader Registration ($0.00)

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

T-shirt Size

School

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

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

Phone Type

Parent/Guardian Email

Address is same as participant*

Address

Would you like to cover the 2.5% processing fee?

Total

$0.00

By filling out this form, you are opting in to Young Life communications.
In the future, you will be given the opportunity to manage your communication preferences.

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

Event Registration Software by RegFox