2026 High School Holiday Inn Lock-In Registration

Student's Name

First

Last

Student Cell Phone

Parent/Family/Guardian Name

First

Last

Street Address

City, State, Zip

Email Address

Home Phone

Parent Cell Phone

Student Date of Birth

Student Age

School Grade

Home Church (if any)

Friends at this church

Special Needs/Allergies/Medical Information/Other:

Emergency Contact

First

Last

Phone Number

Emergency Contact

First

Last

Phone Number

Pick-Up

If not driving, name(s) of person(s) who may pick this child up from the High School Lock-in

Photo Release

The Presbyterian Church has my permission to use my child's photograph publicly in Lock-in materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Aggreement of Terms

I, the undersigned, as the parent/legal guardian of the child named above, do hereby agree to the following terms and conditions regarding my child’s participation in the Holiday Inn High School Lock-in on May 1, 2026.

Assumption of Risk Signature

I understand and acknowledge that my child’s participation in this event may involve certain risks, including but not limited to physical activities, the consumption of food, and interaction with other participants. I voluntarily assume all risks associated with my child’s participation in this event.

Waiver of Liability Signature

In consideration of my child being allowed to participate in this event, I hereby release, discharge, and hold harmless PPC, its employees, volunteers, and members from any and all liability, claims, demands, or causes of action arising out of or related to any loss, damage, injury, or harm of any kind that may occur to my child or their personal property while participating in this event, whether caused by negligence or otherwise.

Medical Authorization Signature

In the event of an emergency, I authorize PPC and its representatives to seek and obtain necessary medical care for my child, including transportation to a medical facility. I understand that I am financially responsible for any medical expenses incurred.

Acknowledgment of Guidelines Signature

I agree to follow all event guidelines set forth by PPC and understand that failure to do so may result in my child’s removal from the event.

Student Signature

I have read all above aggrements and acknowledge that by my signing this form I am taking full responsibility for following all guidelines and rules stated above.

Date