2026 CYIA Summer Missionary Application - Umpqua

Thank you for your interest in serving at CYIA this year! Please fill out this form completely and click submit.

Full Name

Name you prefer to be called (for nametag)

Gender

Please select one option.

Male Female

Grade of school completed

Age (at CYIA)

Please select one option.

12 13 14 15 16 17

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

T-shirt size (Unisex)

Please select one option.

Youth Small Youth Med Youth Large Small Med Large XL 2XL 3XL

CYIA Level

Please select one option.

Blue (age 12) Level 1 Level 2 Level 3 Level 4 Level 5

Why do you want to attend CYIA?

Please briefly explain your salvation experience (returning summer missionaries just type RETURNING)

Signatures

Communication Release: I, the guardian of the above-named minor, give permission to Child Evangelism Fellowship and their staff to solely contact the above-named minor when contacting about CEF affiliated programs or activities. I also give permission for photos to be emailed or texted, if in reference to a CEF related program or activity.

Parent/Guardian Signature

Today's Date

Student Signature

Today's Date

$50 Deposit (Refundable until May 9th)

Deposit $50

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Thank you for your interest in serving at CYIA this year! Please fill out this form completely and click submit.

2026 CYIA Summer Missionary Application - Umpqua

Description

Please Fix the Following