JH: CIY MIX Registration
Depart: July 26th
Return: July 30th

Location: Holland, MI

Cost: $325

$50 Deposit due March 1st

Students must have completed 6th Grade to be eligible.

Payments may be made online through the church website or by calling/visiting the church office.

If your student has earned trip credit through Apple and Pork Parking and you wish to apply this credit to your trip, you MUST do so through Mandi in the office before submitting any other payment. We are unable to offer refunds.
Student Name *
Your answer
Student Birthdate *
MM
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DD
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YYYY
Student will have finished _____ grade by this date: *
Student Email *
Your answer
Student Phone *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Phone *
Your answer
Any special diet/health restrictions for student? If yes, please explain. *
Your answer
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