Summer Registration Form 2017

CUMC YOUTH

2017 SUMMER TRIP

REGISTRATION

Important information concerning scholarships and "Youth Bucks" : All scholarships and youth funds are given on a case-by-case basis. If you are in need of scholarship assistance for youth trips, please submit a scholarship application. If you want to make a payment through your youth ministry account, please contact Beth Lodwick at beth@christumcmobile.com or by calling the church office.

Student Information

If you are an Adult Chaperone please fill out your information in both the Participant and Parent section.

First Name *

Last Name *

Gender *

Age

Grade (current school year 2016-2017) *

School (N/A for Adults)

Student Cell #

Student Email Address *

Parent Information

Parents, please complete all information below. If you are an Adult Chaperone, please repeat your information here

Relationship To Participant *

Parent First Name *

Parent Last Name *

Primary Contact Phone *

Cell Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

CAMP LEE

Middle School and High School Students

June 7th-11th

Pay Deposit ($75) (Youthbucks CAN NOT be used for deposits)

Full Amount ($350)

Waiting List (Scholarship - Registration incomplete until verification)

Adult Chaperone

MIDDLE SCHOOL MISSION TRIP

Middle School Students

July 12th-15th

Pay Deposit ($25) (Youthbucks CAN NOT be used for deposits)

Pay Full Amount ($75)

Waiting List (Scholarship - Registration incomplete until verification)

Adult Chaperone

__________________________________________________________________

SIFAT (Servants in Faith and Technology)

Learn and Serve Summer Camp

High School Students

JULY 23rd-28th

Pay Deposit ($75) (Youthbucks CAN NOT be used for deposits)

Pay Full Amount ($400)

Waiting List (Scholarship - Registration incomplete until verification)

Adult Chaperone

__________________________________________________________________

Current Total:

$0.00