Up All Night 2018
Up All Night is a Jr. High Lock-In at Mt. Pulaski Christian Church. From 8pm-7am we will be playing games, eating snacks, and spending some talking about what JHM is all about. If you have any questions about Up All Night or need to make arrangements for your child to leave or arrive early, please contact Garrett LeVault @ (217) 415-5677 or garrett@mtpulaskicc.org
Student Name *
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Grade *
Student Cell Phone (If Applicable)
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Parent/Guardian Name *
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Parent/Guardian Phone Number *
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Parent/Guardian Email Address *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Relationship to Child *
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Student's Allergies *
If your child is not allergic to anything, please write "NONE" in the space below.
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Student's Prescriptions *
If your child is not taking prescription medications, please write "NONE" in the space below.
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Is there anything we should know about your child before they attend Up All Night?
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Permission Statement
By typing your full name below you are hereby giving your permission that the child in your care named above attend Up All Night at Mt. Pulaski Christian Church on October 19-20, 2018. You are also verifying you have an up to date Liability and Media Release Waiver on file with the church. If you have not done that you can do so by visiting www.mtpulaskicc.org/safe or if you would like to find out if you have one of these on file, please send an email to garrett@mtpulaskicc.org. If you have any questions about Up All Night, please contact Garrett LeVault @ (217) 415-5677.
Parent/Guardian Electronic Signature (Please Type Your Full Name) *
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