2018 Summer Impact Group Registration
Name of Church *
Church Address *
(Include City, State, ZIP)
Church Phone Number *
Church Denomination *
Primary Contact Name *
Primary Contact Title *
Primary Contact Email address *
Primary Contact Phone Number *
Please indicate your first choice of week for participation *
Please indicate your second choice of week for participation *
Which of the following describes the group you are bringing? *
(Check all that apply)
Based on feedback we have received from participants in the past, please indicate whether you would serving groups to be made up of individual church groups, or whether you would prefer a mixing of groups (assuming more than one church is participating in a given week). We make no promises one way or the other for this, we are just seeking to collect preferences and information. *
Why is your group interested in serving in the inner city of Cincinnati this summer?
What questions do you have about Summer Impact?
Are there any special medical or dietary needs for your group? *
Summer Impact requires 1 adult for every 6 youth. At least 1 male and 1 female adult is required for co-ed groups. We suggest more adults for groups of middle schoolers. Please indicate you have read and understand this requirement. *
You are responsible for the transportation of your group. You should always have available seating in one of your vehicles for an intern. Please indicate you have read and understand this requirement. *
(Upon submission of your application, you will receive more information on the suggested vehicle numbers for the size of your group)
Deposit - Please indicate the range in which the number of participants you will be bringing to Summer Impact lies. *
(The corresponding financial amount is the number you will need to send as your deposit for your space to be held)
Please indicate the minimum number of participants you can guarantee. You will be responsible for the corresponding financial costs ($210/person) for the minimum you indicate. There will be no refunds if you bring less than the minimum number you guarantee. *
(Note: the minimum number you indicate should fall in the range of participants you selected above)
Will you need overnight lodging on Friday night? There is a $15/person charge for Friday night lodging. *
(The program should end around 5 PM and you must be from outside the greater Cincinnati area for this offer to apply)
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