Polar Bear Weekend Sign up

WHERE: Clearwater Cove

WHEN: January 18, 2025 - January 20, 2025

Departure: Saturday, January 19, 2025/7:00am

Return: Monday, January 20, 2025/around 2:30pm

COST: $250, a deposit of $100 is required to hold your spot.

Money is nonrefundable after January 6, 2025

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

Questions and Information

Contact Rebekah Lamb at 501-612-9126 or [email protected]

Participant Information

Guest Type

Registration Options

Register with a deposit or full payment ($250.00)
Please select to make a deposit or full payment below. This will be paid by credit card.
Register with Offline Payment ($250.00)
To register without credit card information, select cash/check/offline. This option will also create a payment link for the full. balance listed. We will not hold your spot without a deposit!

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

T-shirt Size

School

High School Graduation Year

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. 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.

Coupon Code

Billing Information

Name

Payment Method

Credit Card
Cash/Check/Offline

Credit Card

Visa
Mastercard
American Express
Discover

Address

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