Aberdeen (Fall 2020)
Locations & Times
What to Expect
Welcome to Mountain
Care & Recovery
Right Now Media
CIY MOVE 2020
CIY MOVE 2020
Student Grade (as of Sept 2020)
Student Date of Birth
Campus you regularly attend
Bel Air Campus
Mountain Road Campus
I do not attend a Mountain Campus
Parent's First and Last Name
Parent's Phone Number
Emergency Contact First and Last Name
Emergency Contact Phone Number
Health Insurance Provider
Health Insurance Policy Number
Refund policy - I have read and acknowledge that no refunds will be given for the deposit of $100. After June 15, no refunds will be given and the full price of the registration will be required. Final payment is due July 1.
Please indicate whether you agree: I release Mountain Christian Church and any other parties acting on behalf of the church from liability in the event of an accident. In the event my child is sent home early while on a trip or event due to an illness, disciplinary action, etc., I will pay for the cost of transportation and/or personally provide return transportation.
Please indicate whether you agree: I am the parent or legal guardian of the child herein, a minor. I understand that there may be occasions when Mountain Christian Church (“MCC”) will want to use photographs or audio or video recordings from Church activities or events in which my child participates. I grant to MCC the right to include photographic, video, audio and other visual or audio portrayals of my child taken during or in connection with Church activities or events in any medium of any nature whatsoever (including the right to edit, combine with other materials or create any type of derivative thereof) for the purpose of advertising, publicity, promotions, or otherwise, without compensation to me or my child. Such grant shall include the unrestricted right to copy, revise, distribute, and display photographs, images, films, tapes, drawings or recordings in any type of media (including, but not limited to, the Internet). I consent to the use by MCC of my child’s testimonial, comments and/or narrative writing in any manner, free of charge, in any form or media. I understand the wording of any testimonial, comments and/or narrative writing may be edited or altered, provided that the sense and meaning are not materially changed. I agree that all rights, title and interest therein shall be MCC’s sole property, free from any claims by me or my child or any person deriving any rights or interest from me or my child. I release MCC and its agents and assigns from any and all claims which may arise out of or are in any way connected with such use.
Photo video release
Please indicate whether you agree: I give permission for medical attention to be given to my son/daughter in case of injury, including major surgery. I understand that I will be contacted as soon as possible in case of an incident.
To ensure the safety of all students we require over the counter and prescription medication be turned in to the trip medication leader. Students cannot self-carry pain relievers, cold medications etc. MCC will have ibuprofen and acetaminophen for headaches or other pain that with your consent, the trip leader may provide to your student according to the directions on the bottle. Cold or allergy medication must be turned into the trip medication leader. Permission to self-carry some medication may be granted by the trip medication leader. A leader will call parents if there is any concern about the health of the student. Indicate below which over the counter medication and pain relievers are acceptable to give to your student:
As part of the registration process, you will need to complete a liability form from CIY. A link to this form will be sent to you in a registration confirmation email. If any additional medication will be administered on the trip, a Medication Administration Form is required. A link to that form will also be available on the confirmation email.