CIY Registration Deposit

who: Anyone in grades 8-12 during the 07-08 school year

what: Christ In Youth is an event designed to encourage students to actively live out their faith everyday.

where: Ft. Lewis College - Durango, CO

when: June 16-21. We will be leaving Southeast at 6:00am on the 16th, and return at 5:00pm on the 21st.

cost: to reserve the following rates, a $50 deposit is due on the dates listed below:
Early-bird rate: $425 (by May 11)
Regular rate: $475 (by June 8)
Last minute rate: $500
Several fundraising opportunities will be made available to help with the cost of the trip.

what to bring: sleeping bag, pillow, toiletries, clothes for 5 days (plus clothes suitable for sports or free rec, and warmer clothes for evenings), Bible and pen, money for 3 fast food meals, spending money for snacks & bookstore (optional). Please no mp3 players.

IMPORTANT: Please bring the following two forms, filled out, with you to give to Southeast staff before the trip departs. Your parent or guardian must fill these out for you to be able to participate in the trip. CIY Medical Form. SSM Medical Form.

questions? contact Jerran Wolf at 720-842-5508 or jerran.wolf@sechristian.org

NOTE: This registration is for the non-refundable deposit of $50. If you would like, instead, to pay the full amount at this time, please click here.

Registration:

General Information

Student's Name*

Grade during 07/08 school year

Check One*
Male
Female

Address*

City*

State*

Zip*

Home Phone Number

Cell or Daytime Phone

Parent(s) Name*

Emergency Contact Name*

Emergency Contact Phone Number*

Parent Email Address*

Medical and Liability Release

We realize that no activity is without the possibility of unforseen hazards which could result in injury to an individual. As a parent or guardian, you are to be aware of your responsibility to instruct your child of the importance of conduct which will insure safety and enjoyable time while participating in this activity. By clicking below, you, as a parent, guardian or other responsible party, agree to assume the risks and hazards which are inherent in this kind of activity. You also agree to absolve and hold harmless the sponsoring organizations and their representatives for damage, loss, or injuries to the child for whom you sign.

I further give my permission for the use of any photo or likeness of my child to be used by the sponsoring organizations for their use in promotional materials.

I give my child permission to participate in this activity, and give my permission to the leaders of this function to authorize any treatment deemed necessary by a licensed physician due to accident or illness during this activity.*

I AgreeI Do Not Agree

Full Parent/Guardian Name*

Date*

Other

Comments

Payment

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