First Calvary Baptist Church

Martin Luther King, Jr. Youth Lock-In Registration Form 2022

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All parents or guardians of youth ages 12-18 attending the Lock-In must complete and sign the contract below by December 30, 2021.

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 in contract.

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




Section 1-Youth General Information:


First Name Last Name


Email Address
Phone Number


Select one
Yes
No




Section 2-Parent General Information:


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



Section 3-Emergency Contact Information: (Cannot be Parent or Legal Guardian)


First Name Last Name

Phone Number
Phone Number



Section 4-Medical History:

Please indicate if your child has any allergies, or any medical conditions that the Lock-In staff will need to be aware of.


**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 for administration.

Select one
I agree



Section 5-Event Items:

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

In the event that a t-shirt is not supplied youth should wear a solid color t-shirt with no logo. Committee will notify participants.

Select one
Yes
No

Food Selection:

Select one
Zaxby's Signature Chicken Sandwich Meal (includes chips, cookie, drink)
Zaxby's 3 Chicken Fingerz Meal (includes chips, cookie, drink)
Select one
Chicken biscuit
Sausage biscuit
Egg & Cheese biscuit
Plain biscuit



Section 6-MLK, Jr. Youth Lock-In Guidelines and Rules:

Participants who do not follow these guidelines can be removed from the lock-in, if necessary.

Dress for Success:

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

NO transparent or revealing clothing.

NO PJ's

Wear event t-shirt, if supplied.

Casual clothing is OK! Sneakers...no black sole boots.

Bring coat/jacket, gloves, scarf, etc. to wear to the MLK, Jr. March.




DO'S LIST:

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

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

Bring a sleeping bag/blanket and pillow.

WEAR MASK AT ALL TIMES.




Don't List:

NO Drugs, Alcohol, and Weapons.

NO Cell phones.

Select one
Yes
No



Section 7-Release of Liabilities and Agreements:

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

Media Release:

Select one
Yes
No

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.
Select one
Yes
No

Liability Release:

I legally bound hereby, release from liability and to indemnify and hold harmless First Calvary Baptist Church/MLK, Jr. Youth Lock-In staff, volunteers, sponsors, 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 possible accident or injury which includes the participant and all third parties present.
Select one
I agree

Medical Release:

I understand that in the event of an emergency or illness, Lock-In staff will first call 911 and have participant admitted to the nearest hospital. After that call, the parent/guardian will be notified.
Select one
I agree

Driving Liability Release:

Due to activities planned throughout the night and the possibility of participants being awake for long periods of time, it is advised that lock-in participants NOT transport themselves to and from the event. Under no circumstances shall First Calvary Baptist Church, all sponsors of the Martin Luther King, Jr. Youth Lock-In, volunteers and staff be liable for any direct or indirect injury to any individual(s) and properties involved in vehicular accidents as a result of refusing to abide by the Martin Luther King, Jr. Youth Lock-In transportation disclaimer.
Select one
I agree

Assumption of Risks and Waiver of Liability Relating to COVID-19:

COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, the West End Community Foundation and First Calvary Baptist Church have put in place certain protocols to reduce its spread. However, the West End Community Foundation and First Calvary Baptist Church cannot guarantee that you or your children will not become infected with COVID-19. The West End Community Foundation and First Calvary Baptist Church are following these enhanced procedures to prevent the spread of COVID-19:*Mask requirements *Social distancing protocols *Following the state mandated number of people for gatherings *Cleaning/Sanitizing of common, high-touch areas *Conducting wellness checks when needed Symptoms of COVID-19 include: *Fever *Fatigue *Dry Cough *Difficulty Breathing. On my behalf, and for and on behalf of my children and our heirs, assigns, and personal representative, I hereby release, Covenant not to sue, discharge, and hold harmless West End Community Foundation, First Calvary Baptist Church and its officers, agents, employees, sponsors and other participants, including all liabilities, claims, actions, damages, cost or expenses of any kind arising out of or relating thereto.
Select one
I agree




First Name Last Name


First Name Last Name




* required