CIY MOVE 2025

CIY Move 2025

June 23rd - June 28th (Early morning)
(Grades entering 9th-graduating seniors)

Sign up by June 1st

This year we are heading to Cleveland, TN at Lee University for an awesome High School week of CIY! (For teens entering 9th grade (2025/26 school year) through current 2025 graduating Seniors).
The total cost is $449 per student. A non-refundable deposit of $75 will hold your spot. There will be fundraising opportunities to offset the cost of CIY, but everyone must pay the $75 deposit. If you have any question please reach out to Amanda Vandeventer (317) 440-7728.

Student's name & age:

Parent name:

Parent's Email

This address will receive a confirmation email

Mobile Phone

Address

MEDICAL RELEASE: I, the undersigned parent or guardian of the above noted minor(s), do hereby authorize adult workers with Valley Mills Christian Church to consent to any examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is rendered under supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. Further, as a parent or guardian of the minor(s) named above, I do hereby expressly consent that my son/daughter may receive emergency medical treatment from any physician, hospital, or other medical center without the necessity of first notifying me, and do further agree to hold blameless any physician, hospital, or other medical center for regarding such services. If my son/daughter is feeling ill or are showing ANY signs or symptoms of sickness, they will not attend this event. I also acknowledge that my son/daughter may have a temperature screening prior to and/or during this event. I agree to hold harmless Valley Mills Christian Church (staff and volunteers) from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss or death from or related to COVID-19. My electronic signature confirms that I hereby give witness to the proper completion of this form by the minor's parent or guardian.

TRANSPORTATION WAIVER AND RELEASE: I, the undersigned, give my consent for the person identified above to be transported by Valley Mills Christian Church's employees and volunteers and will assume all liability for their participation in this activity/event and any injury that may result during the transport or at the event/activity. Further, by signing below: 1. I will not hold Valley Mills Christian Church, its employees or volunteers responsible or liable for injury occurring to the named person in the course of such activities or such travel. 2. I hereby accept financial responsibility for personal items lost by the person identified herein. 3. I accept full responsibility and hereby grant permission for my minor child to travel with Valley Mills Christian Church.

PHOTO RELEASE: I understand that photos and video of each event may be taken to further promote future activities for Valley Mills Christian Church. By signing your electronic signature below you grant permission for the image, photo, video, or likeness of those named to be used by Valley Mills Christian Church and posted on the church website or other social media accounts.

Any special needs or accommodation(s) for the child?:

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

June 23rd - June 28th 2025

CIY MOVE 2025

CIY MOVE 2025

Description

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