Please fill out the following medical release and permission form.

Effective Dates: January 1, 2025 to December 31, 2025

A parent or guardian should complete this form, unless student is 18 years of age or older.

Note: CYIA™ Students are covered by accident insurance while at CYIA Training.

Carefully review the following list of over-the-counter medications that will be kept on hand for medical needs while at CYIA. These items will be given out by a staff member only if necessary. Indicate any that you ­do not want your child to have.

Note: If a participant has serious reactions to food or insect bites that require an Epi-Pen, please send it with your student.

Please send prescription drugs in the original container or in a pharmacy-filled pack with proper dosage and usage inscribed. Mark the student’s name with a permanent pen on all inhalers.

I/We certify that my/our student has permission to attend CYIA and receive the Bible-based instruction provided.

I/We give permission to use photos of my/our student for organizational publicity.

I/We the undersigned have legal custody of the student named above, a minor, and have given our consent to him/her to attend Christian Youth in Action.

I/We acknowledge that all pertinent information concerning any medical, emotional or learning challenges have been made known that possible could affect my child's involvement in this training program.

I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release Child Evangelism Fellowship, its employees or volunteer workers form any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child's involvement.

In case of a medical emergency, I/we hereby give permission to the physician selected by the camp nurse to secure proper treatment for my/our child as named on this form. (You will be notified as soon as possible in case of serious injury or illness.)

In the event that he/she is injured and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by CEF, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising form the giving of such consent.

I/We also acknowledge that I/we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/we affirm that the health insurance information provided above is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above.

I/we understand that if my/our student is sick for over 36 hours, I will have to arrange for transportation home.

I/We also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the CEF staff member.

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.