Winter Retreat Registration

Winter Retreat Registration

CEF of Minnesota
This Registration form is to attend our CYIA Winter Retreat.

The Local Area where you are coming will be approving your registration form in order for you to attend this weekend retreat.
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Birthday*

MonthDayYear
Date
Gender*

MaleFemale
Current Age*
Area (CEF Chapter)*
Where and/or from whom did you hear about Winter Retreat?

Health Care Information
Food allergies
Prescribed medications taken regularly
leave empty if no prescription medications taken
Please list every medication that you/your student plans to bring to retreat. Only one medication on each line.
Health Insurance Company
Policy Number
I hereby certify that my child (listed above) is in good health, free from communicable disease and able to participate in all activities*

YesNo

Parent/Guardian Information
Parent/Guardian Phone Number where can be reached during the retreat*

Area CodePhone Number
Parent/Guardian Email*
example@example.com
Parent/Guardian signature (typed name counts as signature)*
Photo 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.
My photo/video can be used for promotional purposes such as social media posts, ministry updates and newsletters.*

YesNo
Signature to agree to promotional use of my photograph.

Clear

My Products

Winter Retreat$180.00

You can choose to pay here or bring a check when you arrive. If you need information on scholarship opportunities, please reach out to your local coordinator.

Total $0.00

Credit Card

If you are receiving a scholarship via a returning CYIA student, please share their full name below.
Name of CYIA RETURNING Student
Should be Empty:

Winter Retreat Registration

Health Care Information

Parent/Guardian Information

Photo Release

Credit Card