2025 Christian Youth In Action Application (18 and Over)

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

Address (if different)

Phone

T-shirt size (unisex sizing)

Youth Small Youth Med Youth Large Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL

CYIA level you are 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, Code of Conduct, and Dress Code.

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

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

I have completed the medical form.

Yes

Online Screening Application

Please complete the following before you proceed:

1. Read the CEF Statement of Faith.

2. Read and sign the Worker's Compliance Agreement.

3. Read the Child Protection Policy.

4. Watch the 11-minute Protecting Today's Child presentation OR listen at 1-866-878-4182.

5. Gather the following information to enter:
Your salvation testimony
Reference contact information (name, phone, email). This should include your pastor, youth pastor, or church leader, and two personal references. No relatives, please.
Previous addresses (last 5 years)
Social Security Number

6. Complete the online screening application. This will take approximately 15 minutes. (Note: The system will time out after 10 minutes of no activity, and you must complete the form within 40 minutes.)

I have read the Statement of Faith

Yes

I have read and completed the Workers Compliance Form

Yes

I have read the Child Protection Policy and viewed the Protecting Today's Child presentation.

Yes

I have completed the online screening application.

Yes

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Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2025 Christian Youth In Action Application (18 and Over) - Umpqua

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2025 Christian Youth In Action Application (18 and Over) - Umpqua

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