One Wyld Night

WHERE: Seneca Hills Bible Camp

WHEN: March 15, 2025 - March 16, 2025

Departure: Saturday, March 15th - leaving from Butler IHS around 11 am

Return: Sunday, March 16th - arriving back to Butler IHS around noon

COST: $90 - a $25 deposit will hold your spot

Money is nonrefundable after February 1, 2025

After completing this form, a confirmation will be sent with the information you have entered below. There will also be a YL health form (Form 1717) and a Seneca Hills health form to fill out.

Questions and Information

Contact at the Young Life Office at:

Mike Ambuske, Area Director

(937) 207-8951 or [email protected]

Participant Information

Guest Type

Registration Options

Register with full payment ($90.00)
Please select to make a full payment below. This will be paid by credit card.
Register with an offline payment/$0 Deposit ($90.00)
To register without credit card information, select cash/check/offline. This option will also create a payment link for the full balance listed.

Participant Name

Date of Birth

Phone

Phone Type

Participant Address

Gender

Male
Female

Additional Comment

Ethnicity

T-shirt Size

School

High School Graduation Year

Additional Comments

Parent / Guardian Information

Parent/Guardian Name

Parent/Guardian Phone

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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

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