EVERY FAMILY
About Us
Get Started
Locations
Catawba River-Rockhill
Columbia Midlands
Coastal
Greater Pee Dee
Greenville Piedmont
Heart of Palmetto
Lakelands
Lowcountry
Orangeburg Savannah
Santee Wateree
Upstate
Instant Training
Prayer
GIVE NOW
Kids
January 2025
GARDEN CITY CHAPEL & RETREAT
316 Dogwood Dr N., N. Murrells Inlet, South Carolina
AGES 12 to 22
REGISTRATION FORM
DEADLINE: JANUARY 05 2025LIMITED SPACE: ONLY 40 SLOTS
Complete
EVERY
question listed on form below and be prepared to provide a $60 reimbursement fee for costs associated with attending the weekend event. If you have no specific answer for a question, simply add "NA" in the response area.
Failure to answer
ALL
questions or provide the $60 reimbursement fee will hinder your ability to attend.
Once you are registered, you will be contacted by your local CEF office with further details.
ABOUT YOU
Where do you live?
*
Choose One
Catawba River: York, Lancaster, & Chester counties
Coastal: Charleston, Dorchester, & Berkley counties
Columbia Midlands: Aiken, Fairfield, Lexington, Newberry, & Richland counties
Greater Pee Dee: Horry, Georgetown, & Marion counties
Greenville Piedmont: Anderson, Greenville, Oconee, & Pickens counties
Heart of the Palmetto: Florence, Darlington, Marlboro, Chesterfield, & Dillon counties
Lakelands: Greenwood, Abbeville, McCormick, Edgefield, & Saluda counties
Lowcountry: Beaufort, Jasper, Colleton, & Hampton counties
Orangeburg Savannah: Orangeburg, Allendale, Bamberg, Barnwell, & Calhoun counties
Santee Wateree: Sumter, Kershaw, Williamsburg, Clarendon, & Lee counties
Upstate: Cherokee, Laurens, Spartanburg, & Union counties
How did you learn about the CYIA Trailhead Weekend?
*
Choose One
Friend
Presentation
Online
Church
Flyer
Other
Student Name:
*
Student Street Address:
*
Student Email:
*
Father/Guardian Name:
*
Mother/Guardian Name:
*
Birth Gender:
*
Male
Female
City, State, & Zip:
*
Student Church:
*
Father/Guardian Phone:
*
Mother/Guardian Phone:
*
Student Age:
*
Student Grade/Class:
*
Student Phone:
*
Student Pastor / Youth Pastor:
*
Father/Guardian Email:
*
Mother/Guardian Email:
*
Medical information
Should student's activities be restricted for any reason?
*
No
Yes
If YES, explain and provide restrictions:
*
List any major illness this past year:
*
Date of last Tetanus shot:
*
Does student wear:
*
Glasses
Contacts
None
List any food allergies:
*
Food described reaction:
*
Food required intervention:
*
List any medication/medical allergies:
*
List environmental allergies:
*
Med described reaction:
*
Environmental described reaction:
*
Med required intervention:
*
Environmental required intervention:
*
Medications:
Please list all prescription and over-the-counter medications taken routinely. We will administer medications to students upon request or instruction from parent/guardian. Prescription medications must be in their original packaging/bottle that identifies the prescribing physician, the name of the medication, the dosage, and the frequency of administration.
**Please Note: If your student has been prescribed an Epi Pen, make sure it is labeled with their name and they bring it with them to be given to the nurse.
Does student take medication?
*
Choose One
Yes, student takes medication on a regular basis
No, student does not take medication on a regular basis
Medication:
*
Medication:
*
Dosage:
*
Dosage:
*
How often?
*
How often?
*
Taken to treat?
*
Taken to treat?
*
INSURANCE INFORMATION
Primary Medical Insurance Company:
*
Policy Holder's Name:
*
Policy No:
*
Medical Insurance Address:
*
Policy Holder's Address:
*
Group No:
*
Medical Insurance Phone:
*
Policy Holder's Phone:
*
Consent
Check each box to indicate you agree:
*
...I/We certify that my/our child has permission to attend the CYIA Trailhead Retreat.
...I/We give permission to use photos of my/our child for organizational publicity.
...I/We understand that there are inherent risks involved while traveling, in ministry, athletic, or any activity or event and I/we hereby release Child Evangelism Fellowship, its employees, volunteer workers, or anyone associated, including but not limited to family members or associates from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. I/We assume ALL risks in applying, traveling, and/or particapting in this or any other meeting or event sponsored by CEF and anyone, person or organization affiliated.
...In the event that he/she is injured and requires the attention of what is deemed as needed medical attention, I/we consent to any medical treatment as deemed necessary. In the event treatment is required from personnel designated by CEF, I/we agree to hold such person(s) free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.
...I/We also acknowledge that I/we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above.
...I/We also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary for any reason by the CEF staff member.
...In the event of the inability to locate promptly a person designated as parent/guardian, CEF staff may take emergency measures as they deem appropriate and shall notify the parent or legal guardian as soon as possible.
...Participants may be required to submit to a background screening and/or acquiring references. Approval for attending and/or participating any CEF sponsored event may be based in part or whole upon the screening/reference results. CEF maintains the exclusive right of decision who might be approved to participate.
...I/We understand that the $60 reimbursement fee is non-refundable regardless of circumstances.
...I/We understand that completing a registration form and/or providing the $60 reimbursement fee does not guarantee admission to this or any other CEF sponsored event.
...Item number six of the Child Evangelism Fellowship (CEF®) USA Child Protection Policy fact sheet states, “Even when ministry to children is not taking place, an additional adult or minor must be present when two workers are together and one is a minor, unless the minor’s parent or guardian has signed a waiver.” I understand that there may be occasions when my child may be traveling from location to location in the company of only one adult of legal age. Therefore, I, the parent or legal guardian of the listed student, a minor, hereby waive the above requirement for this minor and give my permission for him/her to travel and serve with Child Evangelism Fellowship without being accompanied by two or more adults at any given time.
...The required signature space below indicates I am age 18 or older and legally represent the above named student.
...I understand the typed name below signifies the same affect as my written signature.
MORE INFORMATION
Who is Child Evangelism Fellowship (CEF)?
Where are CEF locations in South Carolina?
What does CEF believe?
What is Christian Youth In Action (CYIA) summer missions?
Where is Garden City Chapel & Retreat?
Can I give so other can participate in CEF's mission?
Required signature of parent/guardian under age 18, or, participant age 18 or older:
*
Submit Registration / Authorization
EVERY FAMILY
About Us
Get Started
Locations
Catawba River-Rockhill
Columbia Midlands
Coastal
Greater Pee Dee
Greenville Piedmont
Heart of Palmetto
Lakelands
Lowcountry
Orangeburg Savannah
Santee Wateree
Upstate
Instant Training
Prayer
GIVE NOW
Kids