2025 7•8 MIX

Participant Contact Information

Student's Name

Parent's Name

Parent's Email

Parent's Phone Number

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Address

Registration Information

Is Student The Child Of A Christ In Youth Staff Member? (Please make sure you have a coupon code for your CIY discount)

Gender

Male
Female

Date of Birth

Grade

Incoming 7th Grade (Fall 2025)
Incoming 8th Grade (Fall 2025)

School District

Name 4 Friends You'd Like To Be In A Group With

Terms & Agreement

Travel and Behavioral Terms and Agreement

TRAVEL TERMS:
As the parent or legal guardian of the above named minor, I give my permission for him or her to participate in 7•8 CIY MIX at Encounter Cove in Roach, MO from June 10-14, 2025. I give my permission for the above named minor to ride in the provided vehicles to and from the event.

I understand, it is my responsibility to have my child at Christ's Church of Oronogo Student Ministry Center East by 12:00pm on Tuesday, June 10, 2025. I further understand, that if the transportation leaves prior to my arrival, that there will be no refund of my registration fee.

The expectation is that each person attends CIY MIX with Christ's Church of Oronogo in its entirety and that they will travel to and from Roach, MO with the group.

I agree to be at Christ's Church of Oronogo, Student Ministry Center East on Saturday, June 14th at 11:00am to pick up my child at the completion of CIY MIX.
**If circumstances change our arrival time, you will be notified by Christ's Church of Oronogo Student Ministry Staff.

I understand and grant permission for my child to participate in outdoor and indoor recreational activities during this event.

I understand that there are inherent risks involved in these activities and hereby release Christ's Church of Oronogo, its staff, and volunteers from responsibility and liability for any injury or illness sustained during this event.

I authorize the minister, adult leader, or sponsor of this event, or any Christ's Church of Oronogo staff member, in the event I cannot be reached by phone, to give consent to a physician and or hospital for emergency medical or surgical treatment. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment.

BEHAVIORAL TERMS:
I understand that if attendee should exhibit behavior that is inappropriate, at the discretion of the Christ's Church of Oronogo staff, they will be sent home from CIY MIX. Transportation will be the responsibility of the attendee's parent or guardian and the registration fee will not be refunded.

I have read and agree to the terms above.

I authorize Christ's Church of Oronogo to use photographs and/or video footage of my child for future promotional material.

Photography Release

By typing your full name, you are electronically signing this form and acknowledging that your online consent is equivalent to a binding legal signature.

Parent/Guardian E-Signature

Today's Date

CIY MIX Medical Release

CIY requires everyone attending CIY MIX to complete a 2025 CIY MIX Medical Release Form. Your child will not be able to participate unless this form has been completed.

**You will receive a confirmation email upon completion of the first step of your registration. Within that email is a link to the CIY MIX Medical Release Form. Please click on this link and complete the form to finalize your registration. **

Medical Information

Medical Insurance Company

Primary Name Insured on Policy

Policy Number

Physician's Name & Contact Number

Allergies

Special Considerations & Dietary Restrictions

Medications Currently Taking

Over-The-Counter Medication Approval

Over-the-counter medications will be available through the camp nurse. These include: ibuprofen, acetaminophen, naproxin, cold medicine, allergy medicine, Dramamine, Immodium, Pepto, Tums, antibiotic cream, hydrocortizone cream, sunscreen and aloe vera.

Please select one of the following options:

I agree to allow my child to receive the above listed over-the-counter medications if necessary.

Please do not administer the following medications to my child:

List any medications that you do not wish for your child to receive. State "All" if you do not wish for your child to be administered any of the above medications.

Parent/Guardian E-Signature

Today's Date

Emergency Contact Information

Primary Emergency Contact

Primary Emergency Phone Number

Secondary Emergency Contact

Secondary Emergency Phone Number

Payment Information

You are required to pay the deposit to secure your registration. You may, however, chose to pay the full amount at this time if you would like. If you choose to pay only the deposit at this time, the remaining balance will be automatically deducted from your account on May 19th.

Have you received a scholarship for this trip?

Make Payment

1st 10 (10% OFF) ($342.00) [Sold Out]
Registration Price ($410.00) [3 remaining]
February 26 - March 12 Early Rate: $380
March 13 - May 18 Regular Rate: $410

Total

$0.00

Coupon Code

Total

$0.00

Scholarship Funding

If you would like to increase opportunities for our students and leaders to attend trips and events through Christ's Church of Oronogo, please enter a donation amount below to contribute to our student ministry scholarship fund.

Your help is greatly appreciated! Thank you for partnering with us!

Donation Amount

Total

$0.00

Terms

I understand that upon completion of the 2025 7•8 CIY MIX Registration that $150 is non-refundable, should I choose to cancel my registration.

I understand that as of 11:59pm on May 19, 2025, my registration fee for 7•8 CIY MIX is due in full and non-refundable.

I have read and agree to the terms above.

By typing your full name, you are electronically signing this form and acknowledging that your online consent is equivalent to a binding legal signature.

Parent/Guardian E-Signature

Today's Date

In between START and FINISH. TAKE OFF and LANDING. DOUBT and CERTAINTY. FEAR and COURAGE. LETTING GO and HOLDING ON.

Participant Contact Information

Registration Information

Terms & Agreement

Medical Information

Over-The-Counter Medication Approval

Emergency Contact Information

Payment Information

Scholarship Funding