JAM Lock In 2018
• Middle School Ministry Lock-In for 5th and 6th grade students

• Friday, January 12 • 9 pm (pick up 7 am following morning)

• $15 includes food, games and T-shirt

Student First Name *
Your answer
Student Last Name *
Your answer
Grade *
School Attending *
Required
T Shirt Size *
Allergies or special concerns?
Your answer
Parent Name *
Your answer
Parent Email *
Your answer
Best phone number to be reached on night of Lock-In *
Your answer
Emergency Contact Name *
(Other than Parent/Guardian)
Your answer
Emergency Contact Phone *
Your answer
Permission to Participate and Photo Release *
To be completed by parent or guardian (18 years or older). My child has permission to participate in the youth activities, programs, and ministries of St Paul Lutheran Church. In any youth event, especially those which include traveling, there is the risk of serious injury. I understand that my child needs to be fully covered under my insurance company. The church's insurance will only cover medical costs not covered by my insurance. In the event of a medical emergency when I, the parent or legal guardian, cannot be reached, I hereby authorize the youth leader, or designated adult counselor, to secure the necessary medical or dental treatment at any hospital, clinic, or doctor's office. I also agree that in no way will the church, youth leader, or adult counselor, be held liable for actions taken in good conscience in an emergency situation.
Required
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