2025 CIY Form

2025 MCC Form (CIY)

CIY Trips & Missions Request
I am a...*

StudentCoach
Participant Information

Please complete as much of this form as possible. Each question provides information which is essential to preparing for the trip.
Which trip are you attending?*

Mix (5-7th grade, July 13-17)Move (8-12th grade, July 7-11)Both
Would you like to request the $100 scholarship from the MCC Missions Team? (students who regularly attend other churches are asked to inquire about assistance at their home church before requesting these funds)*

YesNo
Email Address (the submission notification for this form to be sent to this email, so it could be a parent or student email)*
example@example.com
Participant Name*

First NameLast Name
What is the student's CURRENT grade?*
Participant Gender*

MaleFemale
Participant Cell Phone (if applicable)
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List any preferred roommates in order of preference:
*We cannot promise this WILL be your roommate, but this can help us arrange housing.
1. Name
2.Name
3.Name
If there is anyone you would prefer NOT to share a room with, list them below.
Name(s)
Parent Information

We found out last year that it is helpful to have the following information in the event of a trip to an ER or Urgent Care. Please list the primary insured first. Let us know if you have a preference for ER or Urgent Care should the need arise during the event.
Parent Name (Primary Insured)*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Parent Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Any additional information, medical or otherwise, you'd like us to know for this trip?
Prayer Partner

Each student is paired with a prayer partner who will pray for an encourage the student before, during, and after this trip. Some will request contact information to text or send cards to students. If you have a preferred prayer partner for your student, please list them, along with contact information.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Visit the trip website for details on payment & deadlines

mccookchristian.church/mix OR mccookchristian.church/move
Should be Empty:

2025 MCC Form (CIY)

Participant Information

Parent Information

Prayer Partner

Visit the trip website for details on payment & deadlines