2027 4•5•6 SuperStart

SuperStart 2027 - Real Friends

The friends you choose will shape the rest of your life. But how do you know if someone is a Real Friend? And how do you know if you are being one?

This year SuperStart is diving into Scripture to discover what it truly means to be a Real Friend.

We'll unpack the friendship of Jesus: the friend who washed dirty feet, forgave us even when we didn't deserve it, and laid down his life for others. And the craziest part? He calls us friends, too.

Preteens will learn all of this through an epic Mascot Battle, where your students will decide the outcome of our hilarious mascot competitions and crown one mascot Champion.

Don't miss this chance for your preteens to discover who are their Real Friends.

Participant Contact Information

Student Name

Parent Name

Parent Email

Parent Phone Number

Yes, it's okay to send me text messages including order confirmations, updates, event reminders, and event information. Message frequency varies. Message and data rates may apply. Reply HELP for help, STOP to cancel. View our terms of service & privacy policy.

Parent Phone Carrier

Address

Registration Information

Gender

Male
Female

Date of Birth

Grade

4th Grade
5th Grade
6th Grade

School District

Name 3 Friends You Would Like To Be In a Group With

Terms & Agreements

TRAVEL TERMS:
As the parent or legal guardian of the above named minor, I give my permission for him or her to participate in CIY SuperStart! in Bentonville, AR from January 22-23, 2027. 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 4:30pm on Friday, January 22, 2027. I further understand, that if the transportation leaves prior to my arrival, there will be no refund of my registration fee.

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

I agree to be at Christ's Church of Oronogo, Student Ministry Center East on Saturday, January 23rd at 3:30pm to pick up my child at the completion of CIY SuperStart!.
**If circumstances change our arrival time, you will be notified by Christ's Church of Oronogo Student Ministry Staff.

During the weekend, students will have the opportunity to engage in physical activities including, but not limited to, walking, running, jumping, climbing and roller skating. I understand that there are inherent risks involved in the travel and participation in this event 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 SuperStart!. 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 the participant 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.

E-Signature

Today's Date

CIY SuperStart! Medical Release

CIY requires everyone attending CIY SuperStart! to complete a 2027 CIY SuperStart! 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 SuperStart! 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 & Information

Medicines Currently Taking

Over-The-Counter Medication Approval

Over-the-counter medications will be available through the trip 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 any of 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 "NONE" if you do not wish for your child to be administered any of the above medications.

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

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 a deposit of $50 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 January 6th, 2027.

Make Payment

Click To See Payment Options ($95.00)
Early Registration (October 14 - October 28): $95.00
Regular Registration (October 29 - January 6): $115.00

Coupon Code

Total

$0.00

Terms

I understand that upon completion of the 2027 4•5•6 CIY SuperStart! Registration that $25 is non-refundable, should I choose to cancel my registration.

I understand that as of 11:59pm on January 6, 2027, my registration fee for 2027 4•5•6 CIY SuperStart! 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

Scholarship Fund

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

Billing Information

Secure checkout PCI compliant

Name

Credit CardSecure Payment

Address

Safe & Secure Checkout PCI-compliant • 256-bit AES encryption

This page is secured with 256 bit encryption