CYIA Support Student & One Day Training Application - 2025

This form is to be completed by a parent. The First Name, Last Name and Email is for parent information. Student information will be clarified below.

Your name *

Email address *

Address *

Parent Phone Number *

STUDENT INFORMATION

First Name *

Last Name *

Email *

(if N/A please add parent email)

Gender *

Male

Female

Birthdate *

Does the applicant have any food allergies? If yes, please explain. *

Does the applicant have any environmental allergies? If yes, please explain. *

Does the applicant have any behavioral, learning, or psychological challenges diagnosed or suspected? If yes, please explain. *

Does the applicant have any health conditions and/or physical challenges that would require assistance? If yes, please explain. *

What is the applicant's T-Shirt size? *

EMERGENCY CONTACT INFORMATION

Primary Emergency Contact Name *

Primary Emergency Contact Phone Number *

Primary Emergency Contact Relationship *

Secondary Emergency Contact Name *

Secondary Emergency Contact Phone Number *

Secondary Emergency Contact Relationship *

Transportation Authorization

I give permission for my child to be transported in a motor vehicle driven by the individual(s) that have been screened and authorized by CEF of Florida, Inc. to any event(s) pertaining to the CYIA program. I understand that my child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver and/or other adult volunteers.

Parent/Guardian Signature indicating compliance and agreement with the above. *

Passenger Safety Acknowledgement

I have read, understand, and discussed with my child that:
• They will be traveling in a motor vehicle driven by an adult and they are to wear their safety-belt while traveling;
• They are expected to respect each other, the vehicles they ride in, and the people they travel with during the trip;
• Riding in a motor vehicle may result in personal injuries or death from wrecks, collisions or acts by riders, other drivers, or objects;
• They are to remain in their seats and not be disruptive to the driver of the vehicle.

Parent/Guardian Signature indicating compliance and agreement with the above. *

Transportation Waiver

I recognize that by participating in this activity, as with any activity involving motor vehicle transportation, my child may risk personal injury or permanent loss. I hereby attest and verify that I have been advised of the potential risks, that I have full knowledge of the risks involved in this activity, and that I assume any expenses that may be incurred in the event of an accident, illness, or other incapacity, regardless of whether I have authorized such expenses. As a condition for the transportation received, I, for myself, my child, my executors and assigns, further agree to release and forever discharge Child Evangelism Fellowship of Florida, and its local chapters, its elected governing Board and their agents, officers, employees and volunteers from any claim that I might have myself or that I could bring on my child’s behalf with regard to any damages, demands or actions whatsoever, including those based on negligence, in any manner arising out of this transportation.

Parent/Guardian Signature indicating compliance and agreement with the above. *

Waiver for Minors

Item number six of the Child Evangelism Fellowship (CEF®) USA Child Protection Policy fact sheet states, “Even when ministry to children is not taking place, an additional adult or minor must be present when two workers are together and one is a minor, unless the minor’s parent or guardian has signed a waiver.” I understand that there may be occasions when my child may be traveling from location to location in the company of only one adult of legal age. Therefore, I, the parent or legal guardian of the listed applicant, a minor, hereby waive the above requirement for this minor and give my permission for him/her to travel and serve with Child Evangelism Fellowship without being accompanied by two or more adults at any given time.

Parent/Guardian Signature indicating compliance and agreement with the above. *

Parent/Guardian Authorization & E-Signature

I have read the entire waiver and permission form questions above, fully understand them, and agree to be legally bound by their terms. PLEASE NOTE - Oral requests shall not be honored. Oral permissions shall not be valid. Please note that by initialing the points above and typing your signature, you agree that the electronic signatures appearing on this application are the same as handwritten signatures for the purposes of validity, enforce-ability, and admissibility.

Parent/Guardian Signature indicating compliance and agreement with the above. *

WAIVER AND RELEASE OF LIABILITY

In consideration of the risk of injury while participating in Activity, Christian Youth In Action, and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation and my child's participation in the Activity, and do hereby release and forever discharge Child Evangelism Fellowship of Florida Inc., their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. MY CHILD IS VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND THEY ARE PARTICIPATING IN THE ACTIVITY ENTIRELY AT THEIR OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN, MY CHILD'S OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME AND MY CHILD, OF MY CHILD'S PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY. I agree to indemnify and hold harmless against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If incurs any of these types of expenses, I agree to reimburse. I acknowledge that and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Child Evangelism Fellowship of Florida, Inc. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST FOR PERSONAL INJURY OR PROPERTY DAMAGE. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of Child Evangelism Fellowship of Florida Inc., its agents, and employees. In the event that my child should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment or facilities occurs as a result of my or my child's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

Parent/Guardian Signature indicating compliance and agreement with the above. *

Medical Questionnaire Verification & E-Signature

I hereby give my permission for my child to participate in the CYIA program sponsored by Child Evangelism Fellowship of Florida. I assure the leadership that the applicant is in good health and able to participate. I assure that the information in this registration form is correct and has been completed by a parent/guardian. Please note that by signing this section of the application you agree that the electronic signatures appearing on this application are the same as handwritten signatures for the purposes of validity, enforce-ability, and admissibility.

Parent/Guardian Signature indicating compliance and agreement with the above. *

Parent/Guardian Date of Birth *

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