2025 Christian Youth In Action Application (RETURNING Student)

Full Name

Gender

Male Female

Name you prefer to be called (for nametag)

Grade of school entering

Age (at CYIA)

Birthdate

This address will receive a confirmation email

Address

Phone

Name of parents/guardians

Parent/guardian email

This address will receive a confirmation email

Address (if different)

Phone

CYIA level you will be entering

Why do you want to attend CYIA?

Have you ever led someone to Christ?

Yes No

If yes, when and where?

Does your church plan to use you in any kind of ministry this summer?

Yes No

If yes, please describe.

Are you able to speak another language fluently?

Yes No

If yes, what language(s)?

Do you have any physical problems that may hinder your ability to serve in CYIA?

Yes No

If yes, please explain.

Have you used tobacco in any form?

Yes No

Have you drunk alcoholic beverages?

Yes No

Have you abused drugs in any form?

Yes No

$50 registration fee due when application submitted (refundable until May 17th) $50

CYIA Teachers Agreement

1. I will follow orders of those in authority over me.
2. I have read and understand the CYIA Dress Code and Code of Conduct and I am willing to cheerfully conform to these standards.
3. I commit to attending the entire week-long training school.
4. I have enlisted at least two people to be my prayer partners for my ministry while involved in CYIA.
5. I will work in at least three 5-Day Clubs (or two 5-Day Clubs and another ministry that is the equivalent of teaching in a 5-Day Club as approved by my local director) this summer following the CYIA training school.
6. I will commit to any additional requirements made by my local church or CEF chapter (as defined by my local director).

Please click here to read the Code of Conduct and Dress Code.

I have read and agree to cheerfully conform to the CYIA Teachers Agreement, Dress Code, and Code of Conduct.

Yes

Signature (NOTE: On electronic forms, your typed signature carries the same weight as your written signature.)

Today's date

Photo Release: I hereby assign grant to Child Evangelism Fellowship, Inc. and its subsidaries and successors the unqualified right to the ownership, use and proceeds of all photos of me, without reservation or limitation, including for advertising and promotional purposes.

Signature

Today's date

Transportation Release: I hereby release my child named above to be transported to and from ministry locations during the Christian Youth In Action training week and subsequent summer ministries.

Parent signature (if applicant is under 18)

Medical Form: Please click here to fill out the medical form (have your insurance information ready).

I have completed the medical form.

Yes

Worker's Compliance Agreement: Please read and fill out.

I have completed the Workers Compliance Agreement.

Yes

Signed

Today's Date

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2025 Christian Youth In Action Application (RETURNING Student) - Umpqua

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2025 Christian Youth In Action Application (RETURNING Student) - Umpqua

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