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August 17th-18th 2018 Lock-In Release Form

August 17th-18th 2018 Lock-In Release Form

In order for your child/children to participate this waiver MUST be completed by  Wednesday August 15, 2018
14Questions
  • 1

    Participant Information

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  • 2
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  • 3
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    Pick a Date
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  • 4
    United States
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 5

    Emergency Contact Information

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  • 6
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  • 7
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  • 8
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  • 9

    Informed Consent and Acknowledgement

    In consideration of the opportunity for my child to participate, and fully recognizing that such an undertaking involves an element of risk, I/we assume all risks and hazards incidental to such participation and do herby release, absolve, indemnify, and agree to hold harmless Israel Total Life Ministries, its agents, employees and officers and the chaperones, leaders, organizers, and sponsors and people transporting our child to and/or from these activities.

    I hereby consent to participation by my child in the event described above. I further consent to the conditions stated above on participation in this event, including the method of transportation. In the event of an emergency and I/we cannot be contacted, I/we hereby authorize that emergency treatment may be administered.

    I also grant permission for photographs or video of the minor(s) above to be used for public display as the church deems fit. (ie: website, newsletters, or other means)

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  • 10

    Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

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  • 11
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  • 12

    Code of Conduct

    Failure to adhere to the rules set in place may result in being sent home immediately.

    Behavior for the Whole Event:

    1. Participants will immediately obey the directions of all chaperones.
    2. Participants are NEVER to be alone. Participants will always have a “buddy” or group of “buddies” with them.
    3. Participants are NEVER to be in a private place with a member of the opposite sex (adult or minor).
    4. Participants and Chaperones will notify Elder Ramey immediately if there is a problem or concern.
    5. Participants will respect all property and individuals. (Vandalism, damage due to carelessness and physical harassment are not tolerated)
    6. Participants will “check-in” and not leave the event without notifying Elder Ramey directly.
    7. Participants will adhere to the “Bring/Don’t Bring” list.
    8. Participants may not share sleeping bags or pillows.
    9. No boys in the girl’s room or girls in the boy’s room.
    10. NO personal video games, trading cards, or electronic devices (cell phones will be allowed for emergencies only)

    By signing this you agree to the Code of Conduct and state that you understand the consequences of violating that code.

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  • 13

    Bring:

    Sleeping Bag
    Pillow
    Bible, paper & pen
    Appropriate pajames/slippers
    Tooth brush/toiletries needed
    Pocket money

    Do NOT Bring:

    Electronics (games, iPods, etc.)
    Weapons/Drugs/Alcohol or anything not allowed in school
    Air Mattresses

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  • 14
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