2026 CIY Form

2026 MCC Form (CIY)
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.
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:
*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/Emergency Contact

Please include name and phone number for at least one parent/emergency contact
Name*

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

First NameLast Name
Phone Number
Please enter a valid phone number.
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/move
Should be Empty:

2026 MCC Form (CIY)

Participant Information

Parent/Emergency Contact

Prayer Partner

Visit the trip website for details on payment & deadlines