Lock-In 2018

Student's Name

Parent Email

This address will receive a confirmation email

Parent Phone

Address

Emergency Contact (if above listed parent not available)

Relationship to child:

Emergency Contact Phone

Name of Insurance Company

Responsible Pary

Group Number:

Policy Number

Physician Name

Physician Phone

Please list any medical allergies, medications being taken, medical problems, or other pertinent information:

A Note about Cell Phones: Not every student has a cell phone. We have several students that come from very blessed families and love technology (being married to a tech guru I love technology myself). I know that a few of these students would be ready to take over the church Instagram account if I asked them, and on a lesser scale, could totally Instagram spiritual quotes from the Bible Study and snapchat positive activities at the lock in to friends. However, we also have a whole crop of students that aren’t allowed to have phones, or even iPod’s yet, and many students that, rightfully so, would never get an iPhone for their first phone that they are going to lose or damage. With that said during the lock-in we want to strive to be present with those we are around and create a welcoming and inclusive atmosphere. Cell phones can create two distinct groups within our group and alienate those without. Due to this cell phone use will be restricted to only during hangout time (11pm-1am). If students or parents have concerns or circumstances that would require use otherwise please talk to me otherwise by check the box below to agree upon this usage policy.

I agree to this cell phone policy I do not agree to this cell phone policy

I/We the undersigned have legal custody of the child named above, a minor, and have given our consent for him/her to attend events being organized by the Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/we hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/We consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I/we agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/We affirm that the health insurance information provided is accurate at this date and will, to the best of my/our knowledge, still be in force for the child named above. I/We also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by Hope Lutheran Church Ministry Leadership.

I agree I do not agree (please make notes below)

Parental Signature: By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.

Optional: notes of limitations to above agreement

Description

January 13-14

Please fill out this form for the January 13-14 Lock-In.

I apologize in advance as I know our show choir students will be at the Onalaska Classic. When I made the youth events calendar last fall I did not see that on the school calendar. We wish best of luck to all involved!

Lock-In 2018

Description

Please Fix the Following