2019 Summer Impact Group Registration
Email address *
Name of Church or Organization *
Church/Organization Mailing Address *
(Include City, State, ZIP)
Church Denomination/Organization Affiliation *
Primary Contact Name *
Primary Contact Title *
Primary Contact Phone Number *
Primary Contact Email address *
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 prefer serving groups to be made up of individual 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 population/area is your group EXCITED about serving with? *
(Check all that apply)
What questions do you have about Summer Impact?
Do you anticipate special medical or dietary needs for your group? *
When you finalize your group's registration prior to arrival, we will need to finalize specifics to what special medical or dietary needs your group members have.
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)
Please indicate the number range of participants you anticipate bringing to Summer Impact. The deposit is based on the group size. *
(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 ($230/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 Saturday (before your week of serving) or Friday (after your week of serving)? There is a $15/person charge for each extra night of lodging. *
(The week kicks off on Sunday at 4:00p and ends around 5:00p on Friday.)
To complete your registration and hold your spot, a deposit must be made. You can pay online or mail in a check. Please make check payable to Hyde Park Community UMC and mail to (HPCUMC c/o Kate Smith; 1345 Grace Ave.; Cincinnati, Ohio 45208). *
A copy of your responses will be emailed to the address you provided.
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