CROSS Middle School Trip 2027
July 11-16, 2027 | Please fill out this form and click submit.
Contact Information
Name of YOUTH
*
Grade for 2026-2027 school year
*
Please select one option.
5th
6th
7th
8th
Select Option
5th
6th
7th
8th
Youth Birthday
*
Name of Parent(s)
*
Contact Email of Parent/Guardian
*
This address will receive a confirmation email
Parent/Guardian Phone
*
Emergency Contact Name
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Emergency Contact Phone
*
Health Information
Does your youth have any allergies?
*
Does your youth have any dietary restrictions?
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Does your youth take any prescription drugs? If so please list name, dose, and frequency.
*
Is there any other medical information relevant for your child? (Lingering injuries, mental health, recent surgeries, ongoing medical issues, etc.)
*
Health Insurance Company
*
Policy Number
*
Payment
deposit ($250)
pay in full ($550)
scholarships available (email abigail@downtownchurch.me) (0)
deposit ($250)
pay in full ($550)
scholarships available (email abigail@downtownchurch.me) (0)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
July 11-16, 2027
Please fill out this form and click submit.
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