New Hope Leeward

EPIC High School Ministry

Student Information Parent/Guardian Information

Name:__________________________________ Contact:_______________________

Address:________________________________ Home Phone:___________________

City:___________________ Zip____________ Wk/Cell Phone:_________________

E-Mail:_________________________________ Insurance Company_____________

Phone: _________________________________ Policy #_______________________

Birth Date:________________ Sex:__________

A signed parental consent & policy form, located on the back side is required to attend. There is a $5.00
admission fee that includes provision of food for the night. You will be required to stay from 11:00-7:00 am
unless special arrangements are cleared with your parents. Please note, this event will be video taped for future
youth promotion videos to be shown in the main church service. By signing, you are permitting pictures or
footageand
Allergies of your childHistory
Health to be used. For questions regarding this event please contact Brandon at 561-3222.

Please list any allergies and any other special medical conditions the student may have:

_____________________________________________________________________________

I, _________________________(parent or guardian print name) hereby acknowledge that it is my desire (for my child) to
participate in The Overnight Lock In at New Hope Leeward on Friday June 27, 2008 as a church-sponsored
event of New Hope Leeward, including activities on and/or away from the church premises as well as transportation to and from
such activities. MY CHILD IS VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES, INCLUDING
TRANSPORTATION TO AND FROM SUCH ACTIVITIES, WITH KNOWLEDGE OF THE DANGERS INVOLVED AND
HEREBY AGREE TO ACCEPT ANY AND ALL RISK OF INJURY AS A RESULT OF SUCH PARTICIPATION AND
TRANSPORTATION.

As lawful consideration for permitting me (my child) to participate in such activities, including the transportation to and from
such activities, I hereby release and discharge New Hope Leeward, its officers, employees, agents and members of the Board of
Elders from all actions, claims or demands I and my heirs, distributes, guardians, legal representatives or assigns now have or
may hereafter have for any injury or damages resulting from the negligence or other acts, howsoever caused, by such church,
officers, employees, agents and Board of Elders, before or during my participation in such church sponsored activities on and/or
away from the church premises, including transportation to and from such activities. I HAVE CARFULLY READ THIS
AGREEMENT AND UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND
AN ASSUMPTION OF RISKS AND SIGN IT OF MY OWN FREE WILL.

________________________________________________________________________________________________________
Parent/Guardian Signature Date Student Signature Date

TURN THIS FORM OVER! YOU NEED TO SIGN THE OTHER SIDE ------->
 EPIC LOCK IN POLICIES

1. Admission
a. Doors lock at 11:00pm. Students must have a signed parent permission form, $5.00
entry fee and this form. NO FORMS, NO ENTRY.
b. Parents may chaperone for free child admission. Contact Brandon: 561-3222
2. Parent info
a. Event ends at 7:00am. Pick up is from 7:00-8:00am. Any late pick up after 8:00am
incurs an additional fee of $1.00 per minute that must be paid on site. BE ON TIME!
b. At the end of the event, students may leave on their own if they have a signed parent
note. NO NOTE, NOT ALLOWED TO LEAVE & MUST BE PICKED UP.
3. Boundaries
a. No students allowed outside of Keiki Zone Wing. No use of restrooms or vending
machines without a leader present. Students are not allowed in the sanctuary for any
reason. No one is allowed to leave after 11:00pm without pastoral approval.
4. Behavior
a. No rowdy behavior (i.e. rough-housing, wrestling, playing ball inside, etc.)
b. Girls may not sleep in the guys room. Guys may not sleep in the girls room.
c. There are no showers at the church. Do not expect to shower until you get home.
5. Chaperones
a. Will have 8 leaders and 4 parents to oversee 48 students. This is a 1:4 ratio.
b. 2 parents will be posted in the hallway near the entrance to the mommy’s room
c. There must be an adult present (and awake) in each room that students are in at all
times.
6. Activities
a. Room 1 – Epic Nerf War #1
b. Room 2 – Epic Nerf War #2
c. Room 3 – Movies all night
d. Room 4 – Video games
e. Football or soccer in the back yard
7. What to bring:
a. Bible, journal, pen, Toothbrush, Change of clothes, Sweater (it might get cold), Small
Towel (to wash face in the morning), Sleeping bag or blanket (only if you plan on
sleeping!)
8. Do not bring:
a. Alcohol/drugs, weapons of any kind, sexual paraphernalia (pornography)
b. *We will discourage use of cell phones and ipods during the night because we want
you to make friends with others!

I have read and agree to abide by the above listed rules:

_____________________(STUDENT print name) ________________________(PARENT print name)

______________________(STUDENT signature) ________________________ (PARENT signature)

TURN IN THIS FORM AT THE LOCK IN!

TURN THIS FORM OVER! YOU NEED TO SIGN THE OTHER SIDE ------->