Middle School Lock-In (February 2018)
For 6th - 8th Graders
February 16th - 17th
The Quarter (Oaks)
WHO: Students in 6th - 8th grades (friends are welcome!)
WHAT: A night (and early morning) of FUN with Ignite leaders and friends! Pizza and late-night snacks will be provided on Friday night and breakfast on Saturday morning.
WHEN: Check-in will be on Friday, February 16th at 7:00 PM. Pick-up will be Saturday, February 17th at 9:00 AM
WHERE: The Quarter at the Oaks location (9611 Siegen Lane, 70810)
WHAT TO BRING: Sleeping bag, pillow, toothbrush/toothpaste, pajamas, change of clothes
LIABILITY RELEASE & PARENTAL CONSENT FORM
In consideration for being accepted by THE CHAPEL ON THE CAMPUS for participation in the following activity: Ignite Middle School Lock-In we (I), being 18 years of age or older, do for ourselves (myself) (and for and on behalf of my child participant, if said child is not 18 years of age or older) do hereby release, forever discharge and agree to hold harmless and indemnify THE CHAPEL ON THE CAMPUS and its directors, officers, employees, agents, and anyone else for whom it may be held liable from any and all liability, claims or demands (including attorney fees, defense costs, expenses, court costs, etc.) for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the child participant that occur while said child is participating in the above described trip or activity.
Furthermore, we (I) (and on behalf of our (my) child participant if under the age of 18 years) hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participation in transportation, recreation and work activities involved therein, recognizing the inherent risks and dangers involved in participation in this activity.
Further, authorization and permission is hereby given to said church to furnish any necessary transportation, food, lodging, and medical treatment, including, but not limited to, emergency surgery or medical treatment, and the responsibility for all such expenses incurred is hereby assumed by the participant, and/or his/her parent or legal guardian.
The undersigned further hereby agrees to hold harmless and indemnify said church, its directors, officers, employees, agents, and anyone else for whom it may be held liable for any liability sustained by said church as the result of the negligent, willful or intentional acts of said participant, including attorney fees, defense costs, expenses, court costs, etc. incurred attendant thereto. We (I) are the parent(s) or legal guardian(s) of this participant, and hereby grant our (my) permission to take said participant to a doctor or hospital and to consent to any X-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital and assume the responsibility for all medical bills incurred, if any.
Further, should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, we (I) hereby assume all transportation costs.
I have read and agree to the Liability Form
HEALTH INSURANCE INFORMATION
Must be completed for Student to be able to participate.
Does Student have Health Insurance
Date of Birth
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
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