CYIA Registration Form

SPIRITUAL LIFE
Christian Background and Spiritual Life:

I have trusted in Christ as my personal Lord and Savior.I believe that God has called me to the ministry of CYIA this summerI am in agreement with the CEF Statement of FaithI practice the spiritual dicispline of daily personal devotions
Child Evangelism Statement of Faith
Name of Your Local Church
Pastor's Name
Pastor's Email
example@example.com
Pastor's Phone Number

Area CodePhone Number

How have you grown in your faith this past year?

1. How have you been challenged?

2. How have you seen the Lord work in your life?

3. What book of the Bible are you studying?

4. In what ways are you abiding in Christ?
Type your response here
What motivated you to return as a CYIA™ Summer Missionary?

PRAYER PARTNERS

Please list 3 individuals who will commit to pray for you this summer. These Individuals should be mature adult Christians.
Prayer Partner 1

First NameLast Name
Email
example@example.com
Prayer Partner 2

First NameLast Name
Email
example@example.com
Prayer Partner 3

First NameLast Name
Email
example@example.com

The information contained in this form is correct to the best of my knowledge. I authorize any references listed on this application to give you any information (including opinions) they may have regarding my character and fitness for children’s work. As a volunteer for Child Evangelism Fellowship Inc., I agree to abide by the Child Protection Policy and to refrain from unscriptural conduct in the performance of my services on its behalf. I have read the Child Protection Policy fact sheet and agree to follow the policies and procedures in handling any child abuse situations that may arise. I understand that I am expected to be involved in CYIA Training which includes Practice 5-Day Clubs for the second week. I further understand that I shall receive a certificate upon successful completion of the training course. Student’s Signature
Student Signature
Type your name
Parent or Gaurdian Signature

Photo & Video Release

Child Evangelism Fellowship® may, from time to time, document the activities of the ministry with photos or videos of club activities. I hereby assign and grant to Child Evangelism Fellowship Inc., its subsidiaries and successors, and assign the unqualified right to the ownership, use and proceeds of all photographs or video of me or my minor child, without reservation or limitation, including use of photographs or video of me or my minor child for advertising and promotional purposes.
By typing your name below, you are consenting that photos and videos of your child can be used by the ministry of Child Evangelism Fellowship®. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Printed Name. By printing my name I am consenting that photos and videos of my child can be used by the ministry of Child Evangelism Fellowship®. By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Please Sign the Workers Compliance Agreement

Right Click and 'Open in a New Tab' to sign the Worker's Compliance Agreement
I have reviewed and signed the Worker's Compliance Agreement using the provided link above.
Type Your Name

Waiver For Minors
The Child Evangelism Fellowship (CEF®) USA Child Protection Policy states, “Even when ministry to children is not taking place, an additional adult or minor must be present when two workers are together and one is a minor unless the minor’s parent or guardian has signed a waiver.”

I understand that there may be occasions when my child may be traveling from location to location and/or serving in the company of only one adult of legal age.
Therefore, I, the parent or legal guardian of a minor, hereby waive the above requirement for this minor and give my permission for him/her to travel and serve with his/her teammate, participating in the ministries of Child Evangelism Fellowship, without the presence of an additional adult or minor.
By typing your name below, you are consenting to the Waiver For Minors by the ministry of Child Evangelism Fellowship®. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Signature of Parent or Guardian

Download CYIA Volunteer Support Form

This form can be sent to supporters to raise funds to cover the cost of CYIA Training.

My Products (***Please DO NOT check any additional items in this field if you will not be paying for them today with a credit card*** If you would like to purchase a sweatshirt and/or water bottle it MUST be paid for upon submission of this application)NOTE: All payments made online include a processing fee. If you prefer to avoid this fee please send a cheque directly to the State Office at P.O Box 1866 Glenrock WY 82637. Include CYIA & the student name in the memo line. The registration fee and any items if selected (Sweatshirt or Water bottle) must be paid to complete this application.

CYIA Training Cost ($375)This fee covers all training materials, lodging, meals, and 5 CYIA Ministry T-shirts.

$400.00

CYIA SweatshirtCYIA Sweatshirt 2023. The design pictured here will be different for this year.

$25.00 QuantitySweatshirt Size
Item subtotal:$0.00

Late FeeDue to time needed for ordering materials & supplies for CYIA training and to ensure that every student has the supplies they need on arrival, all registrations must be submitted no later than 01 May of the current year. All registrations received after 01 May will be charged a late fee of $25.

$25.00

CYIA Water BottleWater bottle with CYIA Logo. Supplies are limited.

$15.00

CYIA Registration FeePlease note that this fee is non-refundable and must be paid upon submission of this application form.

$25.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Select this option if you will be mailing a check or have other arrangements with your local chapter. You are responsible for ensuring that all fees are paid in full. All Checks MUST be mailed to PO Box 1866 Glenrock, WY 82637. Please add a note on the memo line "(Student Name)-CYIA".

I will mail a checkI have made arrangements with my Local Chapter
Additional Notes/Comments
Parents, please review the rules and dress code with your child before CYIA Training.
CYIA Packing List
Should be Empty:

CYIA 2023 Returning Student Application Form

SPIRITUAL LIFE

PRAYER PARTNERS

General Medical History

MEDICAL CONSENT/LIABILITY RELEASE STATEMENT

Photo & Video Release

Please Sign the Workers Compliance Agreement

Waiver For Minors

Download CYIA Volunteer Support Form