2026 CYIA Registration Form

2026 CYIA Registration Form

General Information
Student Information

Please submit one form per student
Student Name*

First NameMiddle NameLast Name
Student Email*
example@example.com
Student's Phone Number*
Please enter a valid phone number.
Student's emails and phone numbers are considered sensitive personal information and will be treated as such. Student's emails and phone numbers will be used solely for the purpose of communication related to CYIA Events, Camps, and Clubs, and other CYIA services oppertunities. Student's emails and phone numbers will not be shared with third parties unless required by law and with the parent's explicit permission.
Student Date of Birth*

MonthDayYear
Date
Student Age:*
Enter student's current age.
Sex*

MaleFemale
Current School Name*
School Grade in Fall *
Home Church
Pastor Name
Food or Environmental Allergies or Other Medical Conditions:*
** Enter NONE if student does not have any to list.
T-shirt Size (Adult sizes)*

X-SmallSmallMediumLargeX-Large2X-Large

PARENT 1 - INFORMATION

Required
Parent/Guardian Name*

First NameLast Name
Cell Phone Number*
Alternate Number
Parent E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Do you have legal custody of the child who is being registered?*

YesNo
Does the student reside with Parent 1? If not, enter address of student. *
Home Church of Parent 1
Parent 2 Information
Parent 2

First NameLast Name
Contact Number
Address - If different from Parent 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact / Alternate Pick up
Emergency Contact / Alternate Pickup or Release (other than the parents above)

In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Relation to Student *

Parent Consent Form

Please read and initial after each consent.
Emergency Contact Consent :
I understand and acknowledge the following:

Emergency Contact Information: I have provided accurate emergency contact information, including my contact number, an alternate contact person, and their contact details. In case of any emergency, I authorize the CEF Dallas Staff or CYIA Volunteer staff to contact me or the designated alternate contact.
Parent Initial *
Medical Authorization Consent :
I understand and acknowledge the following:

Medical Authorization: I authorize the CEF Dallas Staff or CYIA Volunteer staff to seek and obtain necessary medical treatment for my child in the event of illness, injury, or any other medical emergency. I understand that the CEF Dallas Staff or CYIA volunteer staff will make every effort to contact me or the emergency contact person before seeking medical treatment, but they may proceed with necessary medical care if deemed urgent.
Parent Initial *
Camp Rules and Expectations Consent :
I understand and acknowledge the following:

Camp Rules and Expectations: I have reviewed and discussed with my child the rules, expectations, and code of conduct for the CEF Dallas - CYIA Training Camp. I understand that my child is expected to adhere to these guidelines throughout the camp duration.
Parent Initial *
Photo and Video Consent :
I understand and acknowledge the following:

Photo and Video Release: I hereby assign and grant to Child Evangelism Fellowship Inc., CEF Dallas, 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.
Parent Initial *
Transportation Consent :
I understand and acknowledge the following:

Transportation: I authorize the CEF Dallas staff and CYIA Volunteer staff to provide transportation for my child as necessary during the camp activities. I understand that all safety precautions will be taken during transportation and all drivers have been background checked.
Parent Initial *
Liability Release :
I understand and acknowledge the following:

Liability Release: I release, discharge, indemnify, hold harmless, and defend CEF Dallas, its staff, volunteers, and affiliates from any all liability (claims, demands, losses, causes of action, suits, judgments) of any kind that I or my family may have against CEF Dallas due to death, personal injuries, illness, accidents, damage or loss of/to personal property, or future causes that occur during the CEF Dallas CYIA Training Camp.
Parent Initial *
5-Day Club Participation Consent:
I understand and acknowledge the following:

CYIA Student 5-Day Club Participation: Every student who attends CYIA is expected to participate in a minimum of FOUR Club events. Students will be able to sign up for clubs that work for their schedule at the end of camp. While we do our best to work with your schedule, all final teaching assignments are made by the CEF staff.
Parent Initial *
*** After submitting this form you will be redirected to the payment page to submit payment for your registered student. The CYIA student rate is $200.00 for the 1st student per household and $125.00 for each additional student in the same household. All student registrations submitted and paid by April 30th, will be charged the $125.00 rate.

Each CYIA student will receive the following: 1 Student Manual, 1 learning supply kit, a 5-Day Club kit w/ bag, a T-shirt, and priceless Gospel sharing tools.

Breakfast & Lunch will be provided during the camp week. Dinner will be provided on Friday, June 5th for CYIA Graduation. Students will need to bring a sack lunch for club weeks.

Additional t-shirts may be purchased for 5-day club week for your student on the payment page.
By signing below, I confirm that I have read, understood, and agree to the terms and conditions outlined in this consent form. I hereby give my permission for my child to participate in the CEF Dallas - CYIA Training Camp, 5-Day Clubs, and all other planned activities and events.
Parent/Guardian Name:*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

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2026 CYIA Registration Form

Student Information

PARENT 1 - INFORMATION

Parent 2 Information

Emergency Contact / Alternate Pick up

Emergency Contact / Alternate Pickup or Release (other than the parents above)

Parent Consent Form

Emergency Contact Consent :

Medical Authorization Consent :

Camp Rules and Expectations Consent :

Photo and Video Consent :

Transportation Consent :

Liability Release :

5-Day Club Participation Consent: