Student Name

Service you will be attending?

Email (required)

School Information

Name of School

Date of Graduation (required)

List any honors or special recognition

Were you involved with a team sport (which one/s)?

Were you a member of any clubs/honor societies (which one/s)?

Church Information

Are you currently involved or have you ever been involved in a D-Group?

Future Plans

Where are you planning on attending college or starting your career?

If you are planning on going to college, what do you plan on studying?

What are your ambitions and aspirations for life after High School/College?

Please submit a Photo of your graduate for the slideshow to Professional photos are preferred. You may send up to two photos to make sure that we have one that will work, however only one photo will be used in publications.

Christ in Youth, a Christian organization dedicated to bringing students to Christ, is offering an exclusive high school student only retreat in Cedarville, Ohio. While there, your student will be asked to focus on God and the plans that He has for their lives. 
Total retreat cost is $360. A deposit of $160 is due in by March 11. The next payments of $100 are due April 8 and May 6. 
Required items 
Medical Release Form -Notorized and turned in by departure date. 

Student's Name (required)

Parent's Name (required)

Parent's Email (required)

Contact Phone 1 (required)

Contact Phone 2

Student's Phone

Gender (required)

Grade (required)