By selecting YES and typing your FULL NAME below, you are hereby giving your permission that the child in your care named above attend CIY MOVE with the Mount Pulaski Christian Church Student Ministry. You are also verifying that all the information on this form is accurate and up to date. You are also verifying that you have an Online Medical Information and Liability and Media Release waiver on file with the church. If you are unsure if you have one of these documents on file, please contact Nate Dyer at
Nate@mtpulaskicc.org. You are also verifying that you understand that the trip costs $350 and you plan to submit payment via cash or check to Nate Dyer or the Mt. Pulaski Christian Church office before the date of the trip. I will be in contact with you after you complete this form giving you some dates for some deposits. Payment may be paid in full to the church by 6/1/20. These checks need to be made out to "Mt. Pulaski Christian Church" and please write "CIY MOVE 2020" in the memo line. If you have any other questions please contact Nathaniel Dyer.