Form | Young Ladies, Big Sandy 1 - Life's Real Journey

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Registration Type(Required)

Price includes program registration ($375) and room and board ($250). Taxes and fees are included.

Alumni Registration Discount

$0.00

Early Registration Discount

$0.00

Total

Personal Info

Email(Required)

Journey Updates

Please subscribe me to the Journey updates email list!

Secondary Email

This is a cc email. For parents or an individual that will be involved with travel.

Prefix

Mr., Mrs., etc.

Name(Required)

First Last

Gender(Required)

Date of Birth(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone(Required)

Cell Phone

Upload Pic

Trouble? Send to [email protected].

Max. file size: 128 MB.

Parents' Full Names(Required)

Parents' Email(Required)

Parents' Home Phone(Required)

Parents' Home Address

If different from your own.

How did you hear about Journey to the Heart?(Required)

Electronics Agreement(Required)

We want to help you get the most out of your time on Journey as possible. You spend a lot of time and money to come here, so we want to help you avoid those distractions that are so hard to ignore today, namely phones and other captivating electronics. During the week, your leader will be the “keeper-of-the-electronics.” Be ready to give your cell phone to your leader after you arrive, along with any MP3 players, laptops, iPods, etc. We will make it possible for you to call your parents and check in during the week.

I have read and agree to this

Terms Agreement(Required)

In the rare circumstance that it would be better for the person or for the team, we reserve the right to separate someone from their team, or to send them home at their own expense and without a refund.

I have read and agree to this

Picture Agreement(Required)

I grant to Journey to the Heart and/or IBLP, its representatives and employees the right to take photographs of me and my property in connection with the functions and activities of or related to a Journey. I authorize Journey to the Heart and/or IBLP, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Journey to the Heart and/or IBLP may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and agree to the above

I also grant to Journey to the Heart and/or IBLP, its assigns and transferees to copyright, use, and publish any photographs or videos that I give to them in print and/or electronically. I agree that Journey to the Heart and/or IBLP may use such photographs or video with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and agree to the above

Consent and Release Form(Required)

I have read and agree to the Consent and Release Form

Comments, Special Needs, or Requests

Coupon

Total

(Cancellations will be refunded with a $50 processing fee.)

Credit Card

If you would like to pay by check or other, please contact us at [email protected] or call 903-636-9484.

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