North Campus Next Level Lock-In PARENT INFO (keep this page) February 6-7, 2016

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1 North Campus Next Level Lock-In PARENT INFO (keep this page) February 6-7, 2016 This year, we are challenging our students to ask themselves, who is ONE FRIEND they know (through school, sports, neighborhood, etc.) who DOES NOT attend church anywhere? The challenge is for our SecondKids to invite that ONE friend to join them for the event. When and where? - February 6-7, 2016 at Second Baptist Church, North Campus - Registration opens at 8:15pm in FLC Pick up: Sunday morning - 10:30 a.m. What is the cost? - Early Registration is $25 per student until February 3rd // $30 Late Registration (Feb 6) - Cost includes event, dinner, t-shirt, prizes, snacks, inflatables, breakfast What is happening? - A worship service with a full band and a Gospel presentation with Pastor Eric. - Pizza, snacks and breakfast items will be served. - If your child has food allergies, please feed them before drop off and/or provide food for them. - Various, high-energy activities themed around The Race. - Minute to Win It games, inflatables, giveaways and prizes. - The students will sleep but you don t have to tell them that yet What do they bring? - TENNIS SHOES (students need comfortable shoes for the entire event absolutely NO FLIP FLOPS) - Pillow and sleeping bag (It gets cold in the building at night) - Jacket (we will go outside weather permitting) + sweatpants and t-shirt to sleep in. - Clean clothes for Sunday morning (we will not be showering) - Personal toiletry items: toothbrush, toothpaste, deodorant, etc. - LEAVE ALL VALUABLES/ELECTRONICS AT HOME (they have no need for them) Where do I get extra registration packets for extra friends? - Next Level Room, Where do I turn in a completed registration packet? - Sundays: Next Level Room (B315) - Weekdays: SecondKids Suite 9am 5pm (3 rd Floor A-Building) Interested in volunteering or have questions? Contact Keri Roberts by at or phone at (713) x1299

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3 Next Level Lock-In February 6-7, 2016 North Student Registration Form Cost: $25 - Early Registration (Until Feb. 3) / $30 - At the door Student s Name: Parent s Name: Address: City: Zip Code: Parent Cell #: Parent School: Birthday: / / Grade: Gender: Boy / Girl Are you and SBC Church member? Y or N If not, where? T-shirt size: Youth M L XL Adult S M L Emergency Contact Name (Other than parent): Emergency Contact Phone Number (Other than parent): Allergies: Current medication your child is taking (We will not administer, please do so before dropping off): Any special instructions/needs: Turn in packets in the Next Level Ministry 3 rd Floor, B-Building or Secondkids Suite Check-in Time: 8:30PM, FLC 108 Pick Up Time: Sunday, 10:30 a.m.

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5 2016 FEBRUARY 6-7 NORTH SECOND KID LOCK-IN WAIVER, RELEASE, AND AUTHORIZATION FOR MEDICAL TREATMENT Name: ( Child ) Address: Phone: Emergency Contact Name: Phone: I represent that I am a parent/legal guardian of the above-named Child. I, and on behalf of all parents and/or guardians, hereby give my Child, permission to participate in the 2016 February 6-7 North Second Kid Lock-In located at Second Baptist Church at Hwy 59 N. Kingwood, TX 77339,, on or about February 6-7, 2016 ( Event ). I represent that my Child is fully released to participate in the Event by his physician or medical provider. I understand that my Child will engage in a wide-range of activities, sports, and games at the Event including, but not limited to, the following: Nerf wars (being shot and shooting others with Nerf bullets), races around campus, skating, dancing, limbo, races, bowling, basketball, baseball/softball, football, volleyball, dodge ball, kick ball, gaga ball, 9 Square in the Air, 4- Square, tag, relay races, leap frog, potato sack races, capture the flag, broomball, wally ball, scavenger hunts, laser tag, rock climbing, water activities, food fights, water balloon fights, water games, toilet paper wars, field games, obstacle courses, silly string battles, low ropes courses, sack races, survivor challenges, eating challenges, sardine game, arcade games, activities on inflatables, and various other indoor and outdoor activities (all of the foregoing are collectively referred to as activities ). I understand the risks of my Child participating in these activities, including severe injury and even death, and I hereby fully assume those risks. I agree that the Student will wear eye protection at all times instructed to do so during the Event. Understanding and assuming all risks, I give my Child permission to participate in all of the activities at the Event. I fully and solely accept both the risks and consequences of my Child s participation and will not seek to recover costs or damages of any kind from Second Baptist Church. I agree that the Child will abide by all rules and will respect the staff, leadership, employees, agents, representatives, chaperones, volunteers, other children/students, and the property of Second Baptist Church or of third parties. I have advised the Child not to engage in horseplay and to follow all directions and instructions. I further understand that I am financially responsible for any damage to public or private property caused in whole or in part by the Child and will reimburse Second Baptist Church within thirty (30) days for any expenses associated with damages or repairs. I HEREBY RELEASE SECOND BAPTIST CHURCH, ITS STAFF, LEADERSHIP, EMPLOYEES, AGENTS, REPRESENTATIVES, CHAPERONES, VOLUNTEERS, AND ASSIGNS; SECOND BAPTIST SCHOOL, ITS STAFF, LEADERSHIP, EMPLOYEES, AGENTS, REPRESENTATIVES, CHAPERONES, VOLUNTEERS, AND ASSIGNS; AND SECOND BAPTIST SCHOOL FOUNDATION, ITS STAFF, LEADERSHIP, EMPLOYEES, AGENTS, REPRESENTATIVES, CHAPERONES, VOLUNTEERS, AND ASSIGNS (ALL OF THE FOREGOING RELEASED PARTIES ARE COLLECTIVELY REFERRED TO AS SECOND BAPTIST CHURCH ) FROM ANY AND ALL CLAIMS AND LIABILITIES OF WHATSOEVER NATURE, BOTH INDIVIDUALLY AND COLLECTIVELY, THAT MAY ARISE FROM MY ABOVE-NAMED CHILD S PARTICIPATION IN THE EVENT, WHETHER OR NOT THE CLAIMS OR LIABILITIES OCCUR ON THE PROPERTY OF SECOND BAPTIST CHURCH OR OF A THIRD PARTY, AND WHETHER OR NOT SUCH CLAIMS OR LIABILITIES ARISE OUT OF THE NEGLIGENCE OR OTHER CONDUCT OF SECOND BAPTIST CHURCH, OR A THIRD PARTY. I further agree that Second Baptist Church representatives have the authority to authorize or provide such emergency medical, dental, and surgical care or treatment and are authorized to make all medical, dental or surgical care decisions as may be necessary in their judgment for my Child during his/her participation in any activities affiliated with Second Baptist Church. I understand that I will be financially responsible for any costs incurred in the emergency treatment and/or transportation of my Child.

6 2016 FEBRUARY 6-7 NORTH SECOND KID LOCK-IN WAIVER, RELEASE, AND AUTHORIZATION FOR MEDICAL TREATMENT - Page 2 I hereby grant permission for the staff, leadership, employees, agents, representatives, chaperones, and/or volunteers of Second Baptist Church to administer over-the-counter medications to the Child including but not limited to: Tylenol, Advil, Tums, Benadryl, Anti-Itch Cream, Triple Antibiotic Cream, Benadryl Cream, Cough Drops, Throat Spray or Lozenges. I agree to notify Second Baptist Church, in writing, prior to the Event, of any of the Child s medical allergies. Second Baptist Church will not administer or disseminate prescription medication. Please make arrangements for your Child prior to the Event. I, THE PARENT/GUARDIAN OF THE ABOVE-NAMED CHILD, HEREBY GIVE OVER AND RELEASE UNTO THE STAFF, LEADERSHIP, EMPLOYEES, AGENTS, REPRESENTATIVES, CHAPERONES, AND/OR VOLUNTEERS OF SECOND BAPTIST CHURCH ALL AUTHORITY AND RESPONSIBILITY TO AUTHORIZE ANY AND ALL MEDICAL TREATMENT NECESSARY FOR THE PROTECTION OF THE HEALTH AND WELL-BEING OF MY AFOREMENTIONED CHILD. THIS AUTHORIZATION SHALL AUTHORIZE ANY AND ALL MEDICAL TREATMENT BY LICENSED MEDICAL PERSONNEL, PURSUANT TO THIS MY EXPRESS AUTHORIZATION, WHETHER WRITTEN OR ORAL, OF THE STAFF, LEADERSHIP, EMPLOYEES, AGENTS, REPRESENTATIVES, CHAPERONES, AND/OR VOLUNTEERS OF SECOND BAPTIST CHURCH. THIS AUTHORIZATION SHALL BE EFFECTIVE UNTIL IT IS EXPRESSLY REVOKED. I understand that the above-named Child may be treated by a volunteer health care provider and that the volunteer health care provider is not administering care for or in expectation of compensation. I also understand and agree that the volunteer health care provider is immune from civil liability for any act or omission resulting in death, damage, or injury as long as the volunteer health care provider acts in good faith and in the scope of his or her duties in providing the health care services. I acknowledge that the Child will be using the facilities of Second Baptist Church and/or facilities owned and operated by third parties. I further understand that the Child may be transported in vehicles and/or equipment owned, leased, or rented by Second Baptist Church and that Second Baptist Church and/or third parties may operate such vehicles and/or equipment. I hereby give my permission for the Child to ride in such vehicles and/or equipment, assume all risk of the Child s transportation, and waive any and all claims against Second Baptist Church that may arise from the Child s transportation to, from, and during the Event. In exchange for allowing the Child to participate in the Event and activities with Second Baptist Church, Second Baptist Church has my permission to use, without compensation, any photographs, videos, graphics, recordings, or other media of the Child for any lawful purposes including, but not limited to, advertising, website/internet, commercials, social media, or any other means of communication. I hereby waive any right of ownership to such media and waive any and all claims the Child or I may have to receive any royalty or other compensation for such use. I have had the opportunity to speak with legal counsel regarding this Waiver, Release, and Authorization for Medical Treatment. I represent that I am authorized to act on behalf of all parents and guardians of the above-named Child. As consideration for allowing the above-named Child to participate in the Event, and on behalf of all parents and guardians of the Child and on behalf of the Child, I give up any and all claims against Second Baptist Church. Parent/Guardian s Signature: Date: Printed Name of Parent/Guardian:

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