First Calvary Baptist Church

Martin Luther King JR Virtual Youth Registration Form 2021

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All parents or guardians of youth ages 12-18 participating in the Virtual Lock-In must complete and sign the attached contract by October 31, 2020.

ONLY youth who have met the mentioned deadline will be allowed admittance into the Lock-In virtual event with NO EXCEPTIONS.

Participants will be added to the Virtual Lock-In from the zoom waiting room beginning promptly at 6:00pm on Sunday, January 17, 2021.

If you have any questions, before or during the Virtual Lock-In please contact Deaconess Janet Squires, Registration Coordinator at 919-606-4801 or email

Section 1-Youth General Information

First Name Last Name

Email Address
Phone Number

Select one

Select one
Select one
Jersey Mike's
Select all that apply
Arts and Craft/Painting
Talent show
Pamper Me/Mini Spa

Section 2-Parent General Information

Parent/Legal Guardian Information:

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

Section 3-MLK, Jr. Youth Lock-In Virtual Guidelines and Rules

Participants who do not follow these guidelines can be removed from the Virtual Zoom meeting, if necessary.

Dress for Success:

NO clothing with profanity, derogatory terms, racial slurs, or sexual content.

NO transparent or revealing clothing. Ladies and Gentlemen should be fully dressed in appropriate attire.

NO PJ's or clothing that would otherwise distract from the seriousness of this virtual event. Casual clothing is OK!


OPEN mind and energy-willingness to enjoy and participate in planned virtual activities.

Use Only Your Real Name. Youth's name on registration form MUST match Zoom ID name in order to gain admittance into the virtual event and remain in virtual event.

Be respectful, orderly, and kind to your peers, facilitators, chaperones, and volunteers at all times.

Be aware of your surroundings. Find a place where you can sit up and be free from any distracting backgrounds.

Enable both microphone and camera when entering the Zoom meeting waiting room.

Keep camera on at all times unless on break or need to walk away from activity.

Mute microphone when not verbally contributing to activity. This will help to limit background noise.

Physically raise your hand or use the "raise hand" feature if you want to speak.

Use appropriate language during Zoom chat feature when utilized by facilitators/coordinators. Zoom chat transcripts will be recorded


NO UNRegistered youth will be admitted into the virtual event.

NO Drugs, Alcohol, and Weapons

NO Disruptive Behavior or use of Profanity.

NO sleeping or laying in beds during the virtual event.

Refrain from eating while Zoom activities are in progress, unless on scheduled breaks.

Do not privately text, chat or engage in other electronic communication during Zoom activities.

Do not use distracting or inappropriate virtual backgrounds.

DO NOT share the Zoom meeting link with anyone. This event is ONLY fo Registered Participants.

NO Readmittance into virtual event once youth logs off. (Special circumstances will need prior approval from Dr. Jacques Wright).

Disciplinary actions and disconnection from virtual Lock-in will be taken for any behavioral issues.

Select one

Section 4-Release of Liability

Note: Due to the nature of the MLK, Jr. Youth Virtual Lock-in, a Liability and Media Release form must be completed prior to joining the virtual event.

By signing below, I agree to ALL the following statements:

I legally bound hereby, release from liability and to indemnify and hold harmless First Calvary Baptist Church/MLK, Jr. Youth Lock-In staff, volunteers, the venue or any of its agents representing the venue there of. I assume all responsibility for medical or any costs that may stem from any posible accident or injury which includes the participant and all third parties present.

Section 5: Media Release

I grant permission for First Calvary Baptist Church/MLK, Jr. Youth Lock-In staff and its volunteers to live stream, tape and use audio/video images of all participants and/or parents.

Section 6: A/V Disclosure Agreement

Audio/Video (A/V) images or any type of recording, including but not limited to photographs, digital images, drawings, renderings, voices, sounds, video recordings, audio clips or accompanying written descriptions. The A/V may be used in any manner or media (e.g., publications, broadcasts, promotions webcasts, advertisements and posters), without notifying registrants. I waive any rights to inspect or approve the finished images or any printed or electronic matter that may be used with them, or to be compensated for them.

First Name Last Name

First Name Last Name

"Event login information will be emailed to registered participants a week before event."

* required