2025 Youth Mission Trip Registration Form

Registration Type

PCCT Member Family/Past Participant Friend/Community Member

Youth Participant Information

Participant Full Name

Preferred First Name/Nickname

Birthdate

Participant Email

Participant Cell

Address

Dietary Needs (provide details in comment box below)

None Food Allergy Vegetarian Other

Comments

T-shirt Size (Adult sizes)

Small Med Large XL 2XL

Grade Completing

9 10 11 12

Parent Contact Info

Parent Name

This address will receive a confirmation email

Cell Phone

Second Parent Name

Second Parent Email

Second Parent Cell Phone

Additional Information

Our family has discussed the nature of this trip and teen participants understand they are expected to participate fully in work projects, group activities and meals.

Yes No

Travel

Participant will travel with the group to and from North Carolina. Departure is scheduled for Sun, June 15. The group will return Sat, June 21. We need to discuss special travel arrangements (please include details in comment box below).

Travel Comment

Fundraiser

All mission trip families are expected to help with the fundraiser on Sunday, May 4 and are asked to contribute a basket or other item for the silent auction.

Participation

Our family will help with set up on Saturday, May 3. Student will help set-up, serve and clean up on Sunday, May 4. Parent(s) will help in the kitchen prior to and/or during the Dinner on Sunday, May 4. Please contact me regarding our availability for this event. I/we can help with pre-event organizing - meal planning, silent auction coordinating, and/or decorations.

Our family will donate an item/basket for the Silent Auction.

Yes! I/we will put together a basket. Please contact me for a description. I/we are happy to provide a basket, but would appreciate few suggestions of what to donate. I am looking for additional information before I commit.

Fundraiser/Silent Auction Comment

Photo Release

I authorize The Presbyterian Church of Chatham Township to use photographs, videos and/or stories of my child (without being identified by name) on the PCCT website, social media (Facebook & Instagram), in the media, or for use within the church (i.e. a trip slideshow).

Yes No

Name of Person Filling Out this Form

Deposit and Payment

For PCCT members and past participants, a deposit of $200 is due with your registration.
For friends/community members, it is recommended that you wait until receving confirmation that space is available before submitting your deposit. A link for online payment will be included in the confirmation email.
To bypass online payment, select "Pay Later or by Check" from the drop down below. Checks should be made payable to PCCT with "YMT" in the memo line and can be dropped off or mailed to the church.
To pay for the trip in full, select "Other" from the drop down and enter the amount ($400 in most cases, $300 if a second participant from the same family).
Partial Scholarships are available. Please contact Pastor Tom for additional information.

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2025 Youth Mission Trip Registration Form

Description

Please Fix the Following