5th / 6th Grade Lock in Form Child's Name * First Name Last Name Age/Grade * 5th Grade 6th Grade Birthdate * MM DD YYYY Parent/Guardian's Name * Phone * (###) ### #### Phone Alternate * (###) ### #### Address * City * State * Zip Code * Email * Allergies or Medical Concerns Notes Permission and Release Agreement * I agree and grant permission to the following Permission and Release statement: PERMISSION AND RELEASE As the parent (or guardian) of the above named attendee, I grant permission for my son or daughter to attend Woodland Hills Baptist Church activities and events and authorize Woodland Hills Baptist Church and its chaperons, to transport and supervise my child in connection with his or her attendance at the various activities throughout the calendar year. I do further hereby give, release, absolve, indemnify, and agree to hold harmless, Woodland Hills Baptist Church, its staff, volunteers, and persons transporting my son/daughter to and from the activity and associated activities from any claim arising out of injury to my son or daughter, except to the extent such harm is the result of the intentional misconduct of Woodland Hills Baptist Church or such other party seeking to enforce this release. As the parent (or guardian) of the above-named attendee of Woodland Hills Baptist Church’s youth activities, I hereby authorize Woodland Hills Baptist Church and its chaperones to seek and have emergency medical first aid administered to the above-named attendee during the year. I give permission for the use of any photos, movies, and audio or video tapings of my child’s activities in connection with Woodland Hills Baptist Church’s youth ministry, to be used with the approval of Woodland Hills Baptist Church for educational or religious purposes, media coverage, or for publicity benefiting educational or religious purposes. Yes Thank you for registering for the 5th / 6th Grade Lock-In!
