Youth Lock-In Nov. 23-24, 2018 REGISTRATION FORM
We are SO JAZZED that you will be joining us for the 2018 Lock-In! Remember, drop-off is at 7pm in Brown Hall and pick up is at 7am at Jennifer's house!

Cost is $20 per youth.

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IT IS IMPORTANT THAT THESE FORMS BE FILLED OUT, SIGNED AND DATED BY THE PARENT OR GUARDIAN AND RETURNED TO THE DIRECTOR OF CHILDREN, YOUTH AND FAMILIES JENNIFER MURPHY. YOUR YOUTH WILL NOT BE PERMITTED TO ATTEND UNLESS WE HAVE RECEIVED ALL FORMS.

 

We at Church of Reconciliation want to inform you of our safety precautions at all of our functions. Your youth will be required by our staff to use the appropriate safety equipment for all activities. Even with safety equipment and our competent staff present, we at Church of Reconciliation want you to realize that any outdoor and recreational activity has inherent dangers that no amount of care, caution, instruction or expertise can totally eliminate.

 

* In signing these documents, I hereby certify that I give permission for my son or daughter to participate in the program offered by Church of Reconciliation Youth Ministry.

 

* I understand that pictures and videos are taken. I hereby give permission for the use of such pictures and videos of my youth for the promotion of Church of Reconciliation.

 

* I hereby give permission to Church of Reconciliation to administer prescribed medications and seek emergency medical treatment: including ordering x-rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to arrange necessary related transportation for my youth. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the appointed sponsor to secure and administer treatment, including hospitalization, for the youth named below. This completed form may be photocopied for trips off site.

 

* I hereby give permission for my youth’s belongings to be searched, with my youth present, when the appointed staff/sponsor deems it necessary to protect the health, well-being, or safety of my youth or others.

 

* I understand that the terms herein are contractual and not a mere recital.

 

* I have signed these documents of my own free act and in consideration of the agreement by Church of Reconciliation to accept my youth for the program chosen.

 

* I HEREBY AGREE BY EXECUTION OF THESE DOCUMENTS TO RELEASE CHURCH OF RECONCILIATION, THE VESTRY, AND ALL OTHERS ACTING FOR OR ON BEHALF OF CHURCH OF RECONCILIATION FROM ALL LIABILITY WHATSOEVER, FOR PERSONAL INJURY, OR INJURIES TO PROPERTY, REAL OR PERSONAL, CAUSED BY, OR ARISING OUT OF ACTIVITIES SPONSORED BY CHURCH OF RECONCILIATION.

 

 

When my youth arrives, I will provide their insurance card(s).*