Student's Name *

First Name

Last Name

Parent or Guardian's Name *

First Name

Last Name

Parent or Guardian Phone *

(###)

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My student will be attending:

CIY Move for High school Students

CIY Mix for Middle School Students

Photo Release *

Do we have permission to post any photos taken of your child at camp on social media?

Yes

No

My student will be participating in fundraising

Yes

No