Lock-In Registration 3/22/24
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Name (First and last) *
Home Church *
Adult Responsible (Youth Leader or other responsible adult who will be in attendance at the event)  *
Grade (6th-12th eligible) *
Emergency Contact (Name and phone number of someone who is NOT at the event) *

WAIVER OF LIABILITY 

I/We  hereby release FIRST PRESBYTERIAN CHURCH of Mattoon from any and all  liability connected with use of the facility on  March 22nd-23rd, 2024.

We acknowledge that we are appreciative of being able to use the church facilities for the planned activity and assume all risk in connection thereto.

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