Youth Lock-in Permission Slip

Parent/Guardian Basic Information

Parent/Guardian Name(Required)
MM slash DD slash YYYY

Youth Basic Information

Youth Name(Required)
MM slash DD slash YYYY
Please enter a number from 10 to 17.
Youth Address(Required)

Emergency Contact


Medical Information

Physician's Name

Things to Bring

1. Sleeping bag/blanket 2. Pillow 3. Pajamas, socks/slippers 4. Personal items (toothbrush, toothpaste, brush, deodorant etc.) 5. Black/dark clothing (long sleeve top and long pants) 6. Special medication or required items (indicate on the permission form).

Lock-in Rules

1. All youth must sign this sheet, indicating their agreement to these rules. 2. No one is allowed to attend the lock-in without a signed parental permission slip and contact numbers. 3. Lock-in participants will not be allowed to go outside of church or venue without adult supervision. No unauthorized entering or exiting. 4. No insults or sarcasm: We do not put others down, make fun of others (especially those who arenʼt with us), pick on others, or gossip about. 5. Use your body respectfully: No revealing clothing, no PDA, no chasing, throwing, or hurting others. 6. Keep it clean: no swearing 7. NO personal video games. Tablets/cell phones will remain put up for the majority of the evening. 8. Special medication or required items should be indicated on the permission form and given to the chaperones. 9. All lock-in participants must respect othersʼ physical boundaries. 10. Same sex sleeping quarters will be provided (for those who wish to sleep). Lights out/quiet hours will be observed in these areas. 11. It is expected that all lock-in participants (youth and adults) will participate in the activities. 12. Take care of yourself and clean up after yourself. 13. Be considerate and respectful of other participants and leaders. 14. Be respectful of the church and property of the church. By signing this permission slip, I understand the following: • Lock-in is designed for youth grades 6-12. • Parents must provide a phone number where they can be reached during the evening in case of emergency. • Parents will be called to pick up their teen if the teen leaves the building for any length of time and/or acts in a manner deemed unacceptable by the Youth Ministries Leaders and/or Chaperones. • Participants should stay home if they are showing signs of communicable illness
Click here to indicate that you and your youth have read the lock-in rules.(Required)
Medical and Liability Release(Required)
MM slash DD slash YYYY
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