CYIA Pre-Training Release Form
May 10th, 9:00 AM - 5:30 PM, at Melrose Community Church in Rosburg
Student Name
*
First Name
Last Name
Student Birthdate
*
-
Month
-
Day
Year
Date
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
CYIA Level
Please Select
Level 1
Level 2
Level 3
Level 4
Level 5
Level Blue
What level will you be at CYIA Camp this year?
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CEF Linn-Benton will caravan from FBC Corvallis to Pre-Training. We will leave at 6:45am, and plan to return at 9:00pm. Would you like to caravan?
*
Yes, I would like to caravan.
No, I have other transportation.
I am 21 or older and willing to transport teens in my vehicle if needed.
CEF will get dinner for teens and volunteers from Linn-Benton after Pre-Training. Would you like to stop for dinner? (If you are part of the caravan, select "Yes!")
*
Yes!
No.
Emergency Contact
*
First Name
Last Name
Emergency Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Medical Insurance Company and Policy #
*
Today's Date
*
-
Month
-
Day
Year
Date
"I hereby release and hold harmless Child Evangelism Fellowship Inc., its staff, volunteers, and the facilities used, from responsibility and liability for any illness or injury that I may sustain during this activity."
*
(Parent/guardian if under 18)
Submit
Should be Empty: