CYIA Application

Contact Information:

Emergency Contact Information:

Emergency Contact 1

Emergency Contact 2

Basic Information:

Personal References (We will send Reference form via Email)

Pastor/Church Leader

Christian Adult 01:

Christian Adult 02: …..

Spiritual Information:…………………………


I understand that Child Evangelism Fellowship will investigate and verify data given on this application.  I authorize all individuals named therein to provide information about me and I release them from all liability for damage in providing this information.

I certify that to the best of my knowledge all answers and information given on this application are true and correct.

By typing your name into the following box you are agreeing to the statement above and is considered your signature on this document