First Name (required)

Last Name (required)

Phone (required)

Email (required)

I give my permission for my child who is named above to attend the Youth Lock-In with Praise Center Church on December 13, 2019. I release the church and all of the adults of responsibility in case of an accident. In the event of illness or accident, I give my permission for any medical treatment deemed necessary by any licensed physician or paramedic be given to my child. I also will assume financial responsibility for the special return of my child if sent home because of the presence of alcohol, drugs, and/or unacceptable behavior. (required)

Emergency Contact Phone

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