CIY Mix Registration (June 25-29, 2017)

Registration & Deposit due by: May 10th, 2017

Departure time: 1:00 PM on Sunday, June 25th

Return time: 2:00 PM on Thursday, June 29th

(Actual program runs June 25th-29th)

Follow These Directions to Sign Up

(1) Scroll down, and fill out the form below.

(2) Turn in your $50 deposit to the church office.

(3) Fill out the CIY Online Medical Release Form.

(4) Turn in your new North Terrace Medical Release Form. We are required to update these at the end of every year to make sure all information is up to date!

(5) Text @NTMix2017 to 81010 to get updates about this event!  

Cost/Financial Assistance

The cost of this event is $294, however we will never allow money to be a barrier. Financial assistance and flexible payment plans ARE available if needed. If you have any questions or would like to seek financial assistance, please contact our student minister.

Stephen Warner (; 740-453-2951, ext. 105)

Registration Form:

Student Name *
Student Name
(Grade you're coming out of)
Student Phone
Student Phone
If you don't have a phone, skip this one!
Parent/Guardian Name *
Parent/Guardian Name
Parent/Guardian Phone *
Parent/Guardian Phone