Emmaus Youth Lock-in Permission Slip (2015)

I grant my permission for (nameofstudent) to participate in the

Emmaus Baptist Church Youth Lock-in on Friday, January 23rd at 7 PM. I also:
Plan to pick up my student at the conclusion of this event at 7AM, Saturday, Jan. 24 th.

Plan to pick my student up at the following time: .

Give my permission for my student(s) to leave this event with .

By signing this permission form:

 I agree to provide an emergency phone number where a parent or guardian can be reached
during the evening in case of emergency.
 I agree to go over event rules (see below) with my student.
 I and my student understand that I will be called to pick up my student if he/she acts in a
manner deemed unacceptable by the Pastor of Student and Family Ministries and/or Adult
Chaperones.
 I hereby grant permission to the church staff/sponsor to obtain services from a licensed
physician in the event of an emergency where medical attention is required.

Signature of Parent or Legal Guardian Date

Signature of Student Date

Emergency Contact Information:

Home Phone Cell Phone

Medical Release Information:

Insurance Co. Policy #:

Name of Policy Holder:

Comments/Medications/Medical Info.

Allergies:
 Emmaus Church Youth Lock-in Parent Information Sheet
Who can attend? Students currently in grades 6 through 12 can attend. Students DO NOT need
to regularly attend Emmaus in order to attend the Lock-in.

When is it? Friday, January 23rd at 7PM until Saturday, January 24th at 7AM. It IS NOT
required that students attend the entire event. Students may leave at any time. However,
students will only be allowed to leave the event with their parent(s) unless otherwise
specified by a parent/guardian (see above).

Where is it? The event will happen at Emmaus Baptist Church (712 N. Linden St. Northfield).

Is there a cost? No. There is NO COST for this event.

Food? Snacks and beverages will be provided. We will have pizza for the students later in the
night. And breakfast will be provided at around 5:30am.

Will there be adult supervision? YES! There will be adult supervision for the entire duration of
the event. It is the policy of Emmaus Youth Ministry that youth events have at least one adult
chaperone for every seven students in attendance.

What will students be doing? There are a variety of games and activities that students will be a
part of. We will also provide snacks, pizza (night), and breakfast (morning) for students.
There will also be a 15- minute bible teaching as a part of the night’s programming.

Do students HAVE to stay up all night long? No. There will be rooms designated for sleeping
(one for girls, and one for boys) if students wish to sleep.

What should my student bring, and what should they NOT bring? Students may want to
bring a sleeping bag and pillow if they plan to sleep. Cell phones, tablets, and other PEDs are
NOT allowed.

Who do I contact if I have questions or concerns? Please contact Pastor of Student and Family
Ministries Abe Johnson by phone (507.884.4115) or by email (abrjoh@gmail.com).

PLEASE GO OVER THE FOLLOWING EVENT RULES WITH YOUR STUDENT:

 All youth must turn in a completed and signed permission form in order to attend.
 Unless other arrangements are specified on the permission slip, each student is expected to stay the
entire night, and will only be released to their parent or guardian.
 Lock-in participants will not be allowed to go outside of church or venue without adult supervision.
 NO personal video games or electronic devices are allowed. Cell phones are allowed
 Any possessions or 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.
 Same sex sleeping quarters will be provided. Lights out/quiet hours will be observed in these areas.
 t is expected that all lock-in participants (youth and adults) will participate in the programing.
Adequate free time will be scheduled for fellowship and socializing.
 Be considerate and respectful of other participants and leaders.
 Be respectful of the meeting place.
 Clean up after yourself.
 Violation of these expectations will result in a parent phone call for their student to be picked up.