Participant Information

PARTICIPANT INFORMATION

Participant’s Name: ______Date of Birth: ______/______/______

Home Address: ______

City: ______State: ______Zip Code: ______Male Female

Contact Numbers: (______) ______- ______(Home) (______) ______- ______(Cell)

E-Mail Address: ______(Participant)

E-Mail Address: ______(Parent/Guardian)

Parent(s)/Guardian(s) Name ______

School: ______Grade: ______

Age: ______FMZBC Membership #______

T-Shirt Size: Small Medium Large 1X 2X

Method of Payment

Ø The participant fee for this event is $20. This includes lodging, 2 full meals, snacks, a t-shirt, a bag, and materials.

Ø Make all checks payable to FIRST MOUNT ZION BAPTIST CHURCH. Returned Check Fee: $ 25.00.

Ø Please do not send cash through the mail. First Mount Zion Baptist Church will not be held responsible if lost or stolen.

Ø Sorry, NO REFUNDS (for planning purposes).

Cash $Personal Check # $__

FMZBC MIDDLE SCHOOL YOUTH LOCK-IN 2015 PERMISSION FORM

I (name of parent/guardian) ______, grant permission for my child, ______to participate in First Mount Zion Baptist Church’s Youth Lock-in 2015 and all planned activities associated with this event. I take sole responsibility for my child’s/my participation in this event and agree not to hold First Mount Zion Baptist Church and any representatives associated with this event liable or responsible for injuries, incidences, and/or medical expenses that might arise during my child’s participation in this activity.

I further understand that my child will be held accountable for his/her actions. If for any reason my child should fail to follow instructions from any Youth Ministry Leader/Coordinator or participates in any activity that may endanger the safety of others, I agree to pick up my child from this activity immediately. I also understand that these actions may prevent my child from participating in future FMZBC Youth Ministry activities.

Medical Matters : I give First Mount Zion Baptist Church permission to get medical assistance for my child in the event of an injury.

Child’s Physician’s Name:______

Name of Insurance Company:______

Policy Number:______Insurance Company Phone No.______

I understand that the servants /staff associated with this event are not authorized to administer medications and I have made necessary arrangements to ensure that medications are administered, if needed. ______(Initial)

Please list any known medical conditions that your child may have. Also lists any medications that your child may have and any medications they are allergic to:

RELEASE: I approve the release of my son/daughter to the following persons if I am not available. ID at the time of pickup will be required.

Emergency Contact: ______Relationship: ______Phone: (______) ______-______

By signing below, I am acknowledging that I fully understand the statements above and sign this Permission Form knowingly, freely, and willingly. My signature provided states that I have read and understand all items outlined.

______/______/_____

Parent / Guardian Signature Date

Thank you for signing up to attend the First Mount Zion Baptist Church Middle School Youth Lock-In 2014. We joyfully anticipate what God has in store for this event. The theme for this event is Grow, which has its biblical roots firmly planted in 2 Peter 3:18 NKJV: “Grow in the Grace and Knowledge of our Lord and Savior Jesus Christ." We encourage each youth to behave in a manner that is pleasing to God. This means following the rules and the instructions of your adult chaperones to ensure that this event goes as planned.

1. Each youth will be expected to be here at 5:00 pm on Friday, February 20, 2015 wearing a red t-shirt and blue jeans. Please arrive on time and enter the facility through the Fitness Center entrance. Report to Room 156 for check in.

2. Each youth will be expected to participate in each group session.

3. Please bring your BIBLE. You will need it in each session.

4. Please do not bring electronic devices. FMZBC will not be responsible for any lost or stolen items.

5. Name tags should be worn at all times.

6. Possession or use of alcoholic beverages, illegal drugs, and tobacco products is prohibited.

7. PLEASE DO NOT attempt to go to unauthorized parts of the building. Listen to instructions and remain in the designated area.

8. There will be attendance taken throughout the lock-in. If a youth is not in the designated places at the designated times or if disciplinary issues occur, then parents will be called to pick up the youth.

9. Dinner on Friday night, snacks, and Saturday breakfast will be provided.

10. Each youth will depart by 9:30 am on Saturday, February 21, 2015. Due to the anticipated FMZ basketball games, please arrive on time and enter the facility through door Q located in the lower rear parking lot. Report to Grain of Heaven for check out.

11. All parents are required to confirm their receipt of the Youth Lock-In Rules and House Keeping document on Wednesday, February 11, 2015 at 5:00 pm via email. Exceptions will only be made for emergency situations.

12. NOT ADHERING TO INSTRUCTIONS & DISRESPECTING ADULT YOUTH LEADERS WILL PREVENT ANY YOUTH FROM PARTICIPATING IN FUTURE FMZBC YOUTH MINISTRY EVENTS!

13. Pray throughout this event that friendships will be formed, trust will start to develop, and that God will reveal Himself to each of you in a special way!

14. The emergency cell number for parents to reach us on during this event is Rev. McNeill’s cell phone: 202-870-0231. This number will be checked every hour on the hour beginning at 5 pm.

Please bring the following items:

Bible

Flash light

SLEEPING BAG & pILLOW

comb /brush

wash cloth

soap

tooth brush and tooth paste

other personal hygiene items

(Friday’s attire: red t-shirts & blue jeans)

(Saturday MOrning’s attire: Lock-In T-shirts & blue jeans)

please do not bring the following items:

ipods

electronic games

Laptop computers

other electronic devices

pAJAMAS WILL NOT BE WORN AT THIS EVENT

cell phones are permitted, but should only be used during a break or free time