Chicago CYIA Application-2024

Thank you for your consideration to serve the Lord with Child Evangelism Fellowship®. You will need to read and complete this form in its entirety for your application to be processed. You will need to e-sign your name as agreeing with these items and a parent or guardian must also e-sign with and for a minor (under age 18). This e-signature is in place of a traditional written one and is legally binding.

- The dates are June 11-June 21 and will be an overnight camp. However, as June 16th is Father’s Day, students will go home at 4pm June 15th in order to spend time with family and do laundry. They will need to return on June 16th at 5pm.

- The cost of training is $400 for each student. A $50 nonrefundable fee, which will go towards the total cost, will be required at the bottom of this application. If preferred you can pay the full amount at this time as well.
 
-  Training will be held at The Lithuanian World Center. The address is 14911 120th Street Lemont, IL 60439..

NOTE: This application will not self-save. If you navigate away from this page, you will have to start over. For the "Personal Testimony" section, it is recommended that you use a separate program to write your testimony out, and then copy and paste it into this application. We are so thrilled that you would like to attend CYIA 2024. All of the information entered here is secure, private and confidential and will not be shared with anyone outside those considering your application.

If you have questions or need assistance, please contact us at 312-725-3294 or cefchicago@gmail.com.

Be Blessed!

~Chicago Child Evangelism Fellowship Missionary Team

Notice of Non-Discriminatory Policy
Child Evangelism Fellowship® admits students of any race, color, ethnic origin, and nationality to all rights, privileges, programs, and activities available through our training programs.
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Email *
CYIAer Information
First Name *
Middle Initial
Last Name *
Preferred name on your name tag
Age *
Date of Birth *
CYIAer gender *
Mailing Address - Street Address *
Mailing Address - City *
Mailing Address - State *
Mailing Address - Zip Code *
CYIAer Cell phone number *
Parent Cell phone number *
Do you have texting on your phone? *
CYIAer Information
Required
E-mail address *
CYIAer Information
Personal Testimony *
Please write a few paragraphs describing your own testimony of when you were saved. How do you know that you are saved? Include Scripture references to back up your belief.
Parent/Guardian Information
Parent e-mail address *
Parent/Legal Guardian First Name/s *
Parent/Guardian Information
Parent/Legal Guardian Last Name/s *
Parent/Guardian Information
Parent/Legal Guardian Phone *
Parent/Guardian Information - enter multiple phone numbers if available
Church Information
Church Name *
Church Address *
Church Information - City, State, Zip
Other Important Information
Available weeks to teach 5-Day Clubs *
Being available means you are able to teach each day (M-F) of the week from approximately 9:30am-8:00pm. If you have special circumstances that prevent "whole day" availability, please let us know and we will work with you on an individual basis.
*Please Note that every CYIAer is strongly encouraged to teach at least two weeks of 5-Day Clubs after the initial 10-day training. The more you teach the better teacher you will become and the more ministry you will get to be part of!
Required
T-Shirt Size *
Required
Special Dietary Needs
*The food service staff at CYIA does not include a Registered Dietician. Therefore, any student or staff member with physician-diagnosed food allergies or any other eating disabilities will be responsible for supplying food substitutions to accommodate unacceptable menu items for their diet.
Medical Information & Release
Does the CYIAer have any medical conditions (e.g. asthma, diabetes, hypothyroidism, depression, ADHD, dyslexia, etc)? What do you do to take care of this condition? *
Does the CYIAer have any allergies? *
Does the CYIAer have any recent physical issues? Please explain and describe care and activity level. (E.g. Sprained ankle using crutches can get around fine. Broken arm in a cast doesn't affect me much. Pulled muscle not supposed to run for 3 weeks but I can walk with my brace. Recent tingling that makes me unable to walk when it starts, no control or cause known.) *
Does the CYIAer have any other health concerns or history of health concerns that we should know about? *
I give absolute right and permission to use my photograph(s), likeness or image(s) in a publication, electronic media (e.g. video, Internet, CD-ROM), or other forms of promotional materials for Child Evangelism Fellowship®. No payment will be made for the use of images taken or submitted by you. I release CEF®, their offices, employees, agents, designees, and the photographer from liability for any violation of any personal or proprietary right I may have in connection with such use. I hereby state I have read carefully and understand the foregoing and know the contents thereof, and I state my agreement with this e-Signature. It is a legally binding agreement as my own free act. *
CYIAer E-Signature (Type Name)
I give absolute right and permission to use my photograph(s), likeness or image(s) in a publication, electronic media (e.g. video, Internet, CD-ROM), or other forms of promotional materials for Child Evangelism Fellowship®. No payment will be made for the use of images taken or submitted by you. I release CEF®, their offices, employees, agents, designees, and the photographer from liability for any violation of any personal or proprietary right I may have in connection with such use. I hereby state I have read carefully and understand the foregoing and know the contents thereof, and I state my agreement with this e-Signature. It is a legally binding agreement as my own free act. *
Parent/Gardian E-Signature (Type Name)
I give permission for the aforementioned minor to participate in activities with Child Evangelism Fellowship®. I will not hold Child Evangelism Fellowship and/or its representatives responsible for any injury, illness, or mishap that may occur to the above person. I authorize the designated CEF® representative to sign consent for treatment and release of medical records, whenever required. This person may also sign for medical reimbursements, with my own insurance being primary coverage(Applies to minors only). This E-Signature is legal and binding. *
Parent/Gaurdian E-Signature
Required $50 Down Payment *
Application Completed!
Hit Submit, and you'll be finished with your application for CYIA 2024!
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