Lock in Registration

Name of Youth

My child/youth has permission to attend the lock in Feb. 16th from 8 pm - 7 am at Dover First UMC

Parent/ Guardian Signature

Primary Contact and Relation to child/youth

Primary Phone Number

Secondary Contact relation to child/youth

Secondary Phone Number 

Does your child/youth have any conditions that would prevent them from fully participating in the event?  If yes, please explain.

Please list any medications that will need to be taken during the time frame of the event. (Note: All medications will be kept with the adults in charge.)

Does your child/youth have any allergies? If yes, please list.