Permission Slip

I hereby grant my permission for

____________________________________________________________________,
Name of youth

To participate in the activity mentioned above beginning Friday, November 20th at 7 PM

until I pick him/her up on Saturday November 21st at 9:30 AM at 40th Street Cove, 3928
Pacific Ave., Virginia Beach, VA, 23451

By signing this permission form, I understand the following:

• 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 son or daughter is he/she leaves the building
for any length of time and/or acts in a manner deemed unacceptable by the
Director of Youth Ministries

_____________________________________________ __________________________
Signature of Parent or Legal Guardian Date signed

Medical Release Information

Name _________________________________________ E-mail Address

____________________________

Address
__________________________________________________________________________________

__________________________________________________________________________________________

Contact ___________________________________ _________________________________

Home Phone Number Cell Phone Number

In the event of an emergency where medical attention is required, I hereby grant

permission to the church staff/sponsor to obtain services from a licensed physician.

Comments/Medical Info.
____________________________________________________________________

Insurance Co. __________________________________________ Policy #

_________________________

Signed by parent or guardian _____________________________________________________

Date: ______________________________________________________
 Lock-In Rules
• All youth must sign indicating their agreement to these rules.
• Unless other arrangements are made with a parent or guardian, each student is
expected to stay the entire night, and will only be released to their parent or guardian.
• No one is allowed to attend the lock-in without a signed parental permission slip and
contact numbers. Parents may be called to verify if there is doubt.
• Lock-in participants will not be allowed to go outside of church or venue without adult
supervision, and if this rule is broken the parent will be called and expected to pick up
their teen regardless of the hour.
• NO personal video games, trading cards, or electronic devices
• Any possessions are bags must be surrendered at entrance to the lock-in venue.
Special medication or required items should be indicated on the parent permission
form.
• No illegal drugs, alcohol, dangerous materials, or firearms.
• All lock-in participants must respect others’ physical boundaries. Inappropriate
behavior (i.e.
• Physical intimacy or sexual harassment) is not permitted.
• Same sex sleeping quarters will be provided. Lights out/quiet hours will be observed in
these areas.
• It is expected that all lock-in participants (youth and adults) will participate in the
program. Adequate free time will be scheduled for fellowship and socializing.
• Violation of these rules will result in disciplinary action and may include the participant
being asked to leave the lock-in. Parents will be called to pick them up.
• Take care of yourself
• Be considerate and respectful of other participants and leaders
• Be respectful of the meeting place.
• Clean up after yourself.