First Calvary Baptist Church

Copy of MLK Registration Form 2019

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All parents or guardians of youth ages 12 - 18 attending the Lock-In must complete and sign the attached contract by December 30,2018. ONLY youth who have met the mentioned deadline will be allowed admittance to the Lock-In with no exceptions. Registration will begin promptly at 6:00pm. There will be NO WALK-INS. All youth participants are to come dressed in age appropriate clothing as outlined below and in the contract. If you have any questions, before or during the Lock-In please contact Janet Squires, Registration Coordinator at 919-606-4801 or email

First Name Last Name

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Parent/Legal Guardian Information:

First Name Last Name
Address Line 2
City State Zip Code
Phone Number
Phone Number
Email Address

Emergency Contact Information: (Cannot be Parent or Legal Guardian)

First Name Last Name

Phone Number
Phone Number

*____ This event will be recorded and photographed, please check if you wish for your child NOT to be recorded or photographed.

Medical Release Form

In the event of an emergency or illness, Lock-In staff will first call 911 and have child admitted to the nearest hospital. After that call the parent/guardian will be notified.

Medical History

**Lock-In staff will NOT administer ANY medications, therefore if your child is on medication notify Lock-In staff upon check-in and child or guardian will be responsible. I affirm that the above information is true and accurate to the best of my knowledge and hereby release First Calvary Baptist Church and its affiliates from and all liability resulting in injury while participating in the activities.

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Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
Adult XXX-Large

Dress Code

In the event that a t-shirt is not supplied youth should wear a solid color t-shirt with no logo. Youth should also bring a coat/jacket to wear to the MARCH. If you plan to play any sports you may bring clothes to change into. Clothing should be comfortable, NOT tight.

Sleep Time

Youth will have an opportunity to sleep. They can bring sleeping bags, and any other item for peaceful rest. Understand youth will be responsible for transporting all items brought with them.
* required