New Hope Leeward EPIC High School Ministry

OVERNIGHT LOCK-IN!
Parental Consent Special Event Form
Student Information Name:__________________________________ Address:________________________________ City:___________________ Zip____________ E-Mail:_________________________________ Phone: _________________________________ Birth Date:________________ Sex:__________ Parent/Guardian Information Contact:_______________________ Home Phone:___________________ Wk/Cell Phone:_________________ Insurance Company_____________ Policy #_______________________

A signed parental consent & policy form, located on the back side is required to attend. There is a $5.00 admission fee that includes provision of food for the night. You will be required to stay from 11:00-7:00 am unless special arrangements are cleared with your parents. Please note, this event will be video taped for future youth promotion videos to be shown in the main church service. By signing, you are permitting pictures or footage of your child to be used. For questions regarding this event please contact Brandon at 561-3222. Allergies and Health History

Please list any allergies and any other special medical conditions the student may have: _____________________________________________________________________________
I, _________________________(parent or guardian print name) hereby acknowledge that it is my desire (for my child) to participate in The Overnight Lock In at New Hope Leeward on Friday June 27, 2008 as a church-sponsored event of New Hope Leeward, including activities on and/or away from the church premises as well as transportation to and from such activities. MY CHILD IS VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES, INCLUDING TRANSPORTATION TO AND FROM SUCH ACTIVITIES, WITH KNOWLEDGE OF THE DANGERS INVOLVED AND HEREBY AGREE TO ACCEPT ANY AND ALL RISK OF INJURY AS A RESULT OF SUCH PARTICIPATION AND TRANSPORTATION. As lawful consideration for permitting me (my child) to participate in such activities, including the transportation to and from such activities, I hereby release and discharge New Hope Leeward, its officers, employees, agents and members of the Board of Elders from all actions, claims or demands I and my heirs, distributes, guardians, legal representatives or assigns now have or may hereafter have for any injury or damages resulting from the negligence or other acts, howsoever caused, by such church, officers, employees, agents and Board of Elders, before or during my participation in such church sponsored activities on and/or away from the church premises, including transportation to and from such activities. I HAVE CARFULLY READ THIS AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND AN ASSUMPTION OF RISKS AND SIGN IT OF MY OWN FREE WILL. ________________________________________________________________________________________________________

Parent/Guardian Signature

Date

Student Signature

Date

TURN THIS FORM OVER! YOU NEED TO SIGN THE OTHER SIDE ------->

EPIC LOCK IN POLICIES 1. Admission a. Doors lock at 11:00pm. Students must have a signed parent permission form, $5.00 entry fee and this form. NO FORMS, NO ENTRY. b. Parents may chaperone for free child admission. Contact Brandon: 561-3222 Parent info a. Event ends at 7:00am. Pick up is from 7:00-8:00am. Any late pick up after 8:00am incurs an additional fee of $1.00 per minute that must be paid on site. BE ON TIME! b. At the end of the event, students may leave on their own if they have a signed parent note. NO NOTE, NOT ALLOWED TO LEAVE & MUST BE PICKED UP. Boundaries a. No students allowed outside of Keiki Zone Wing. No use of restrooms or vending machines without a leader present. Students are not allowed in the sanctuary for any reason. No one is allowed to leave after 11:00pm without pastoral approval. Behavior a. No rowdy behavior (i.e. rough-housing, wrestling, playing ball inside, etc.) b. Girls may not sleep in the guys room. Guys may not sleep in the girls room. c. There are no showers at the church. Do not expect to shower until you get home. Chaperones a. Will have 8 leaders and 4 parents to oversee 48 students. This is a 1:4 ratio. b. 2 parents will be posted in the hallway near the entrance to the mommy’s room c. There must be an adult present (and awake) in each room that students are in at all times. Activities a. Room 1 – Epic Nerf War #1 b. Room 2 – Epic Nerf War #2 c. Room 3 – Movies all night d. Room 4 – Video games e. Football or soccer in the back yard What to bring: a. Bible, journal, pen, Toothbrush, Change of clothes, Sweater (it might get cold), Small Towel (to wash face in the morning), Sleeping bag or blanket (only if you plan on sleeping!) Do not bring: a. Alcohol/drugs, weapons of any kind, sexual paraphernalia (pornography) b. *We will discourage use of cell phones and ipods during the night because we want you to make friends with others!

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I have read and agree to abide by the above listed rules: _____________________(STUDENT print name) ________________________(PARENT print name)

______________________(STUDENT signature)

________________________ (PARENT signature)

TURN IN THIS FORM AT THE LOCK IN!

TURN THIS FORM OVER! YOU NEED TO SIGN THE OTHER SIDE ------->