Youth Seminar

June 12–28, 2026 | Roanoke, VA

PERSONAL INFORMATION

First name

Last name

Birthday

Month

Day

Year

This event is for 12 years or older.

Address

Email

Phone

Add country area code (example +1)

EMERGENCY CONTACT

Parent, guardian, etc.

Name (Parent, guardian, etc)

Phone (Parent, guardian, etc.)

Add country area code (example +1)

City, State

MEDICAL HISTORY

List any medications you take

List any allergies (including food allergies)

Physical difficulties that we should be aware of

PARTICIPANT’S AGREEMENT

Please read the Guidelines for Conduct before signing below.

I agree to respect those in responsibility, to do my part in fulfilling the purpose of this seminar, and to abide by the Guidelines for Conduct at all times. I understand that should I fail to do so, I will be sent home at my expense and will forfeit all registration fees.

Full name

Date signed/submitted

Month

Day

Year

By checking this box you agree to electronic signature

PLEASE WRITE A SHORT DESCRIPTION OF WHY YOU WOULD LIKE TO ATTEND THIS SEMINAR.

FINANCIAL INFORMATION

Cost, including food and lodging for the seminar program, is USD $480.

Pricing

Seminar $480 (lodging and all meals)

Seminar $175 (lunch only no lodging)

Need Bedding

No (bringing my own)

Yes ($20 linen charge)

Cleaning Deposit (refunded if room is left clean)

$50 (refundable cleaning fee)

Prices for those attending with youth but not part of the seminar (parents, guardians, etc.)

Pricing

Lodging and food $450 (lodging and all meals)

Lunch only $140 (entire seminar)

Lunch only per meal $12 (advance notice required)

If a parent or guardian wants to be listed as an official chaperone (with the associated responsibilities), they need to contact us and there will be no charge if approved.

If making payment online please include full name along with payment. Failure to do so may result in money being lost.

Payment Options

Online Payment (PayPal: treasurer@VCsdarm.org | Zelle: treasurer@VCsdarm.org)

Pay in Person

PARENT’S AUTHORIZATION

If you are under the age of 18, a parent must sign. If 18 or older, please sign for yourself.

Parent's Signature

By checking this box you agree to electronic signature

Date signed/submitted

Month

Day

Year