CIY Move Registration

If you plan to go to CIY with the Student Ministry this summer, please fill out the registration form. There is a $65 nonrefundable deposit to hold your space at camp. If you choose to pay in full but have to cancel you will be refunded the payment minus the $65 deposit. If you have multiple children, please register them separately.

Student Information

Name

*

Phone

Email

Birthdate

*

Grade

*

Please select one option.

9th 10th 11th 12th

Parent/Guardian Information

Parent/Guardian Name

*

Parent/Guardian Relationship

*

Please select one option.

Mother Father Grandmother Grandfather Aunt Uncle Other

Parent/Guardian Email

*

This address will receive a confirmation email

Parent/Guardian Phone

*

Payment

Nonrefundable deposit (65.00) Trip in full (389.00)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

If you plan to go to CIY with the Student Ministry this summer, please fill out the registration form. There is a $65 nonrefundable deposit to hold your space at camp. If you choose to pay in full but have to cancel you will be refunded the payment minus the $65 deposit. If you have multiple children, please register them separately.

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