Summer Stretch Registration Form
Summer Stretch is a summer ministry program for middle school youth in grades 5 – 8 and high school students in grades 9 – 12, during the 2018/19 school year.
Registration deadline: May 22, 2019.
Registration Instructions: Completed the following form and pay the $135 non-refundable fee and $40 Volunteer Buyout fee, if applicable, to a participating Church Office, or pay online at
. A small processing fee will be added to all online credit or debit card payments. Checks are payable to Centennial Area Summer Stretch (CASS).
Financial aid is available – contact a Summer Stretch Coordinator for more information.
Date of Birth
Participant or Youth Leader
Participant (Completed 6th - 8th Grade)
Youth Leader (Completed 9th - 12th Grade)
Student Cell Phone Number
Parent(s) or Guardian(s) Name(s)
Home/Daytime Phone Number
Parent/Guardian Cell Phone Number
Parent/Guardian email address where you would like program information sent
Church Member at
Grade Completed Spring of, 2019
T-shirt size (Adult sizes)
My son/daughter has my permission to participate in all Summer Stretch program activities from June 10 through June 14, 2019. Should a situation arise, I give the adult leaders permission to seek the necessary medical attention for my child. Summer Stretch reserves the right to use the above named person’s picture in any Summer Stretch publications or other media presentation. A "yes" response represents an electronic signature.
Yes, I agree with the above statement and agree that this serves as my electronic signature.
No, I do not give my child permission to participate in Summer Stretch.
Preferred Hospital or Clinic
Name of Insurance Provider & Policy Number
Allergies, medical or other concerns
Please select any days your child will NOT be attending Summer Stretch
Monday, June 10
Tuesday, June 11
Wednesday, June 12
Thursday, June 13
Friday, June 14
My child will attend all days.
Can I be with a friend? Students may request ONE friend to be in your same small group. Summer Stretch will do their best to accommodate the request. Youth Leader requests are not accepted. There is no switching once requests are made. Please include first and last name of friend and what grade they will complete spring of 2019.
Making Summer Stretch Work: A parent (or other responsible adult 21 years or older) of each participant is required to help at Summer Stretch for one volunteer shift (Monday, Tuesday, Wednesday, Thursday mornings) or a full day (Friday). Youth Leader parents are encouraged to serve, but are not required. You will only be assigned to work one shift unless you indicate otherwise. Volunteers on Friday will spend the whole day with our Summer Stretch group. If you choose Friday, your afternoon activity fee will be covered by Summer Stretch. Volunteer times are as listed. Check all shifts you are available.
Monday, June 10; 8:30 a.m. - 12:00 p.m.
Tuesday, June 11; 8:30 a.m. - 12:00 p.m.
Wednesday, June 12; 8:30 a.m. - 12:00 p.m.
Thursday, June 13; 8:30 a.m. - 12:00 p.m.
Friday, June 14; 8:30 a.m. - 4:30 p.m.
I am willing to help with more than one shift.
I am not able to help and will pay the buyout fee (informion below).
Volunteer Buyout Option: Because lives are busy and we know that volunteering is not an option for everyone, we are offering a $40.00 buyout for anyone who does not want to, or cannot, volunteer their required shift. Parents who do not volunteer their required shift during the summer will receive an email reminder of their volunteer buyout balance at the end of the Summer Stretch week.
I am choosing to pay $40 to opt-out of volunteering for Summer Stretch and will pay the additinal $40 at the time of registration.
I will volunteer my assigned shift.
Key Adult Volunteers: Key Volunteers come each day and lead one specific area (e.g. assigning drivers, coordinate the Watershed District, bake and deliver cookies, represent Summer Stretch on a daily basis at one of our service sites, etc.). Being a Key Volunteer waives the fee for one participant or youth leader. If you are interested in more information, please contact a Summer Stretch Coordinator.
I am intersted in learning more about current Key Volunteer roles.
I am not intersted in serving in a Key Volunteer role.
I understand that my registration is not complete until I have paid $135, plus $40 for Volunteer Buyout, if applicable, to a participating Summer Stretch church or paid online. A small processing fee will be added to all online credit or debit card payments. Click here to pay online: (
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service