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2018 CIY Super Start Registration Form

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Event Information


Super Start (4th/5th Grade Students)
March 9-10 // Bloomington, IL // Cost $75
If you have any questions, please contact Kelly Murbarger at 618-554-7739 or
(Financial assistance is available if needed. We do not want money to be a determining factor for a student to be unable to attend the event. Please contact Kelly for inquiries.)


Student *
Parent/Guardian's Name *
Parent/Guardian's Name
Parent/Guardian's Phone *
Parent/Guardian's Phone
*I give my consent for my student to attend Super Start with Highland Church of Christ. *I will pay the $75 registration fee (cash or check to HCC) by March 4th, 2018. *I will fill out the CIY eMRF (emergency Medical Release Form) as it is made available to me.