CYIA 2023 New Student Application Form

CYIA 2023 New Student Application Form

Parents and students please fill out the form carefully & completely for registration.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
T-Shirt Size

SmallMediumLargeX-Large2X-Large
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number

Area CodePhone Number
Parent/Guardian Name
Parent/Guardian Number

Area CodePhone Number
Emergency Contact Name

First NameLast Name
Emergency Contact

Area CodePhone Number
CEF Chapter
Please upload your photo for your Christian Youth In Action ID card. ** Please note that this should be a decent photo, not a goofy picture**

Cancelof
Take Photo

SPIRITUAL LIFE
Christian Background and Spiritual Life:

I have trusted in Christ as my personal Lord and Savior.I believe that God has called me to the ministry of CYIA this summerI agreement with the CEF Statement of FaithI practice the spiritual dicispline of daily personal devotions
Child Evangelism Statement of Faith
Name of Your Local Church
Pastor's Name
Pastor's Email
example@example.com
Pastor's Phone Number 1

Area CodePhone Number

PERSONAL TESTIMONY

“If someone asks about your hope as a believer, always be ready to explain it. But do this in a gentle and respectful way” (1 Peter 3:15-16, NLT) Please Take a few minutes to work through the following questions and write out your story as if you were telling it to someone. This will allow you to be ready for the next open door God gives you to tell your story.
My Life Before Christ

1. What about my life before Christ will relate most to the non-Christians I know?

2. What did my life revolve around? Where did I get my security, identity or happiness from?

3.How did those things begin to let me down?
Type your response here:
How I Came to Christ

1. When was the first time I heard the gospel? What were my initial reactions?

2. When and why did my perspective of Christ begin to change?

3. What were the final struggles that went through my mind just before I accepted Christ? Why did I finally decide to accept Christ (or give Him complete control of my life)?
Type your response here:
My Life After Coming to Christ

1. How is my life different now? List some specific changes in your character, attitude and perspective on life.

2. What motivates me now? What do I live for?

3. Even though my life still isn’t perfect, how does knowing Christ help me deal with that fact?
Type your response here:
Why do you want to be a CYIA™ Summer Missionary?

EXPERIENCE HISTORY
Have you taken any training conducted by Child Evangelism Fellowship (CEF) before?
What training and experience have you had that will help you work with children this summer (VBS, Children's Church AWANA etc.)?
What leadership experience do you have that will help you as a CYIA summer missionary (Positions of leadership held in clubs, church activities, etc.)?

PERSONAL REFERENCES

Please list 2 references who are non-relatives other than your Pastor listed previously
Reference 1-Non-Relative

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Reference 2: Non-Relative

First NameLast Name
Address ' '

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Please send the Reference Report Form below to your listed references to complete and return to your Local Chapter Director.

R icardoHosein@cefwyoming.com (Northwest)

AnnaDurney@cefwyoming.com (Northeast)

AnthonyFrail@cefwyoming.com (Southeast)

JimmyLundy@cefwyoming.com (Central)

Info@cefutah.org (Mr. Terry Thurman, Utah)
Please copy and save this link. Send to your Pastor and two non-relatives to complete.

Reference Report

PRAYER PARTNERS

Please list 5 individuals who will commit to pray for you this summer. These Individuals should be mature adult Christians.
Prayer Partner 1

First NameLast Name
Email
example@example.com
Prayer Partner 2

First NameLast Name
Email
example@example.com
Prayer Partner 3

First NameLast Name
Email
example@example.com
Prayer Partner 4

First NameLast Name
Email
example@example.com
Prayer Partner 5

First NameLast Name
Email
example@example.com

The information contained in this form is correct to the best of my knowledge. I authorize any references listed on this application to give you any information (including opinions) they may have regarding my character and fitness for children’s work. As a volunteer for Child Evangelism Fellowship Inc., I agree to abide by the Child Protection Policy and to refrain from unscriptural conduct in the performance of my services on its behalf. I have read the Child Protection Policy fact sheet and agree to follow the policies and procedures in handling any child abuse situations that may arise. I understand that I am expected to be involved in CYIA Training which includes Practice 5-Day Clubs for the second week. I further understand that I shall receive a certificate upon successful completion of the training course.
Student Signature
Parent Signature

Photo & Video Release

Child Evangelism Fellowship® may, from time to time, document the activities of the ministry with photos or videos of club activities. 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 advertising and promotional purposes.
By typing your name below, you are consenting that photos and videos of your child can be used by the ministry of Child Evangelism Fellowship®. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Signature of Parent or Gaurdian

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 a minor, hereby waive the above requirement for this minor and give my permission for him/her to travel and serve with his/her teammate, participating in the ministries of Child Evangelism Fellowship, without the presence of an additional adult or minor.
By typing your name below, you are consenting to the Waiver For Minors by the ministry of Child Evangelism Fellowship®. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
Signature of Parent/ Legal Guardian
By typing your name below, you are consenting to Consent & Release Form. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Download CYIA Volunteer Support Form

This form can be sent to supporters to raise funds to cover the cost of CYIA Training.

Select this option if you will be mailing a check or have other arrangements with your local chapter. (However, you are responsible for ensuring that all fees are paid in full. All Checks MUST be mailed to PO Box 1866 Glenrock, WY 82637.

I will mail a checkI have made arrangements with my Local Chapter
Additional Notes/Comments

My Products (***Please DO NOT check any additional items in this field if you will not be paying for them today with a credit card*** If you would like to purchase a sweatshirt and/or water bottle it MUST be paid for upon submission of this application. If you are unable to pay for a sweatshirt or water bottle now you can use the sweatshirt order form found on the CYIA tab at www.cefwyoming.com to order by the 15th MAY. NOTE: All fees paid online include a processing fee. The registration fee must be paid upon submission.*** The CYIA fee of $375 can be paid online or directly to the State Office at P.O Box 1866 Glenrock WY 82637. Include CYIA & the student name in the memo line if sending a cheque)

CYIA Training FeeThis fee covers, all training supplies, room & board, and 5-Day Club T-Shirts. ($375 due after payment of registration fee).

$375.00

CYIA SweatshirtCYIA Sweatshirt 2023. The design pictured here will be different for this year. If you choose to order a sweatshirt at a later time please use the sweatshirt order form on the CYIA Tab at www.cefwyoming.com.

$25.00 QuantitySweatshirt Size

Late FeeDue to time needed for ordering materials & supplies for CYIA training and to ensure that every studenIt has the supplies they need on arrival, all registrations must be submitted no later than 01 May of the current year. All registrations received after 01 May will be charged a late fee of $25.

$25.00

CYIA Water BottleWater bottle with CYIA Logo. Supplies are limited.

$15.00

CYIA Registration FeePlease note that this fee is non-refundable and must be paid upon submission of this application form.

$25.00

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Parents, please review the rules and dress code with your child before CYIA Training.
CYIA Packing List
Please save and forward this link to 2 References. One of which must be your Pastor.

CYIA Reference Report
Should be Empty:

CYIA 2023 New Student Application Form

SPIRITUAL LIFE

PERSONAL TESTIMONY

EXPERIENCE HISTORY

PERSONAL REFERENCES

PRAYER PARTNERS

General Medical History

MEDICAL CONSENT/LIABILITY RELEASE STATEMENT

Photo & Video Release

WAIVER FOR MINORS

Download CYIA Volunteer Support Form