2026 Mission Trip: Let it Shine! - Maquoketa, Iowa

Student Participant Name

Guardian/Parental Email

This address will receive a confirmation email

Non-Refundable Commitment Payment $325

By clicking this box, I acknowledge and agree that I am submitting a non-refundable $325 payment to reserve a space for the student participant listed above. This $325 covers the cost of essentials that can not be reimbursed.

Yes, by clicking this box, I acknowledge that I am submitting a non-refundable $325 payment to reserve a space for the student participant listed above.

By clicking this box, I acknowledge that this trip is estimated to cost upwards of $675 in total per participant. By clicking this box, I agree to assist with fundraising and/or additional self payments to fund the total expenses of the trip for the student participant listed above and/or group expenses.

Yes, by clicking this box, I agree to assist with fundraising and/or additional self payments to fund the expenses of the trip for the student participant listed above and/or group expenses. I understand that this trip will cost $675 per participant.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

This form is a non-refundable commitment payment. The $325 payment reserves the space for the student participant. The two boxes that must be checked are a commitment to funding and understanding the commitment of this trip. Please contact Youth Director Kurtis Arndt with any questions.

2026 Mission Trip: Let it Shine! - Maquoketa, Iowa

Description

Please Fix the Following