Rock Solid

New years Lock-in

Parent Waiver

I hereby grant my permission for my child to participate in the New Years Lock-in beginning Thursday, December 31st at 7:00 PM until they are picked up on Friday, January 1st at 7: 00 AM at The Rock Church Youth Center, 3078 HWY 101, Bridgeport, TX 76426.

By signing this permission slip, I understand the following:

All youth must be in grades 7-12.
Parents must provide a phone number where they can be reached during the evening in case of an emergency.
Parents will be called to pick up their teen if the teen leaves the building for any length of time and/or acts in a manner deemed unacceptable by the Youth Ministries Leaders and/or Parent Chaperones.

Parent/Guardian

Email Address

Student

Student: Date of Birth

Parent/Guardian Phone Number

In the event of an emergency where medical attention is required, I hereby grant permission to the church staff/sponsor to obtain services from a licensed physician.

Yes

Please list any relevant medication/allergies or other medical information:

*If none type none.

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!