Student Registration

Christian Youth In Action

Student Registration - If more time is needed this form maybe saved by selecting "Save" at the end of the form.
I will be attending - (Please Select one)*

Registrations Closed ---- Southern Idaho Training School June 9-13 & June 16-20Northern Idaho Training School 23-27 & July 7-11
First
Middle
Gender:

MaleFemale
Last
Birth Date

MonthDayYear
Date
Age
Street Address
TownCity
State
Zip code
Phone
School Name
Grade 2023-2024 school year
Parent/Guardian - Contact Information

Parent/Guardian #1
First
Last
Street Address
TownCity
State
Zip Code
Phone
Work Phone
Email
example@example.com
Parent/Guardian #2
First
Last
Tee Shirt Size - At Clubs team members will have a Tee Shirt for each day.*

Youth SmallYouth MediumYouth LargelAdult SmallAdult MediumAdult LargeAdult Extra LargeAdult 2 Extra LargeAdult 3 Extra Large
Street Address
TownCity
State
Zip Code
Phone
Work Phone
Email
example@example.com
Emergency Contact Information - Alternate Pickup/Release Emergency Contact #1
First
Last
Home/Cell Phone
Work Phone
Email
example@example.com
Relation to child
Emergency Contact #2
First Name
Last
Home/Cell Phone
Work Phone
Email
example@example.com
Relation to Child
Please complete the attached documents:

1. Medical Questionnaire

2. Minor Waiver

3. Video Release Form

Deposit/Tuition for CYIA Training & Payment Policies:

Three levels at Christian Youth In Action Training school. Our goal is to equip teams of young people to go out and teach 5-Day Clubs.

1st Jr-CYIA, for first time and younger students, a training school notebook and Tee shirts. During the summer clubs will be assisting Missions and Bible teachers in the 5-Day Clubs. Will focus on "How to lead a Child to Christ", motions for the songs and helping with games.

Jr-CYIA tuition $75.00: due (minus any deposit) with application by May 15th.

2nd Missions teacher, returning and older students, will receive a training school notebook, Tee shirts and a 5-Day Club kit. Responsibilities: Along with everything the Jr-CYIA does, they will be prepared to teach the Memory verses, Review Games, Word up and the missions story.

Mission teacher tuition $150.00: due (minus any deposit) with application by May 15th.

3rd Bible teacher, returning missions student, will receive a training school notebook, Tee shirts and a 5-Day Club kit. Responsibilities: Along with everything the Missions teacher can do they will be prepared to teach the Bible Lesson, and able to lead club, including High Octane games.

Bible teacher tuition $150.00 : due (minus any deposit) with application by May 15th.
I am registering for:

Jr-CYIAMissions TeacherBible Teacher
CYIA Training Participant Agreement

I, the undersigned parent, hereby release discharge, indemnify, hold harmless, and defend CEF of IDAHO, its officers, employees, and servants from any and all liability (claims, demands, losses, causes of action, suits, judgments) of any kind that I or my family may have against District due to death, personal injury or illness, loss or damage to property, or future causes that occur during the CEF OF IDAHO TRAINING. In the event of any medical emergency, I authorize and consent to act on my behalf for medical care deemed necessary for the participant.

I, the undersigned student, have read and understand the CYIA Code of Conduct. I agree to follow this Code as I participate at CYIA and in other CEF activities.
Applicant Name please print
Applicant Signature*

Clear
Date

MonthDayYear
Date
ParentGuardian Name please print
ParentGuardian Signature

Clear
Date

MonthDayYear
Date
Medical Questionnaire

(To be filled out by parent or guardian if the applicant is under 19)
Name

First NameLast Name
Age
Date

MonthDayYear
Date
Medical Coverage for Applicant
Name of Insurance Company
Policy #
Address of Company
Date of last tetanus shot

MonthDayYear
Date
Is the applicant subject to:
Asthma

YesNo
Hay Fever

YesNo
Epilepsy

YesNo
Food Allergies

NoYes: List foods
Allergfies to medications

NoYes: List medications
Other allergies (flowers, grasses, etc.

NoYes: list alergies
Has the applicant had:
Chicken Pox

YesNo
Rheumatic Fever

YesNo
Mumps

YesNo
Rubella (German Measles)

YesNo
Measles

YesNo
Serious reaction to bee stings

YesNo
Note: If a participant has serious reactions to food or insect bites that require an Epi-Pen, please send it with your student
Does the applicant have:
Diabetes

YesNo
Special Diet

NoYes: What is it?
Hypoglycemia:

YesNo
Has the applicant had any illness requiring a visit to the doctor or hospital in the last 3 months?

NoYes: If so, what was the health problem?
The nurse carries the following stock items. Please mark any you do not want your child to receive
Aleve/Naproxen

No
Ibuprofen

No
Tylenol

No
Ointment

No
Benadryl

No
Tylenol Sinus

No
Cough Elixir

No
Cough Drops

No
Imodium

No
Mylanta

No
Pepto-Bismol

No
Tums

No
Orajel

No
Tears

No
Acetaminophen

No
Antacid Chews

No
This is a Day training, if needed please send prescription drugs in the original container with proper dosage and usage inscribed. Mark the student’s name with a permanent pen on all inhalers

Please list any prescription drugs being brought by the applicant:
Name of Medication:
What it is for:
Dosage:
Name of Medication:
What it is for:
Dosage:
Name of Medication:
What is it for:
Dosage:
In case of a medical emergency, I hereby give permission to the physician selected by the school nurse to secure proper treatment for my child as named on this form. (You will be notified as soon as possible in case of serious injury or illness.)
Signature of parent or guardian

Clear
Type Name
Phone Number
Please enter a valid phone number.
Address
City/State/Zip
If unable to notify me in case of an emergency, please contact:
Relationship
Phone Number
Please enter a valid phone number.
Photography and video Release

Child Evangelism Fellowship® may, from time to time, document the activities of the ministry with photos or videos. 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, but not limited to, advertising, educational and promotional purposes.
Students Name
If student is under 19 parent’s first and last name
City
State
Zip
Phone Number
Please enter a valid phone number.
Email
example@example.com
Having read the release please indicate your agreement and signature below

Clear
Type name
Date of Signature

MonthDayYear
Date
I am an adult age 18 or older.

YesNo
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 blanks a minor, hereby waive the above requirement for this minor and give my permission for him/her to travel and participate in the ministries of Child Evangelism Fellowship, without the presence of an additional adult or minor.
Signature

Clear
Date

MonthDayYear
Date
Typed name of parent or guardian
Address
City/State/Zip
Phone Number
Please enter a valid phone number.
Email
example@example.com
The Local Director or Coordinator will contact new students to set up an Interview and Information Meeting.

All Students please share your salvation testimony below.

Be sure all the following documents are completed by May 15th or for new students before your interview.

1. Application (available online)

Medical Questionnaire

Photo/Video Release Form

Minor Waiver Form.

2. Ministry Compliance Agreement (available online)

3. Code of Conduct Form (available online)

4. Give to your pastor the Pastoral Reference form

5. Necessary registration fees or deposit (payable by mail or online)

New Students - If not already arranged, contact Local CEF Office to arrange an in-person interview.
Please share your salvation testimony below.*
Thank you for completing the registration, please return to "cefofidaho.com/christian-youth-in-action/" page and download the Pastoral Reference form for your pastor. You may print it or email to your pastor.
Should be Empty:

Christian Youth In Action

Medical Questionnaire

Medical Coverage for Applicant

Is the applicant subject to:

Has the applicant had:

Note: If a participant has serious reactions to food or insect bites that require an Epi-Pen, please send it with your student

Does the applicant have:

The nurse carries the following stock items. Please mark any you do not want your child to receive

This is a Day training, if needed please send prescription drugs in the original container with proper dosage and usage inscribed. Mark the student’s name with a permanent pen on all inhalers

In case of a medical emergency, I hereby give permission to the physician selected by the school nurse to secure proper treatment for my child as named on this form. (You will be notified as soon as possible in case of serious injury or illness.)

Photography and video Release

Waiver For Minors

Thank you for completing the registration, please return to "cefofidaho.com/christian-youth-in-action/" page and download the Pastoral Reference form for your pastor. You may print it or email to your pastor.