Youth's Name *

First Name

Last Name

Youth's Phone Number

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Name *

First Name

Last Name

Parent's Phone Number *

(###)

###

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Parental Permission *

I hereby grant my permission for my child to participate in the Youth Lock-In at Albany First Baptist Church on September 30th beginning at 7pm and ending on October 1st at 7am. By signing this permission slip, I understand the following: • All youth must be in grades 7-12. • Parents must provide a phone number where they can be reached in case of an emergency. • Parents will be called to pick up their teen if the teen leaves the building and/or acts in a manner deemed unacceptable by leaders/chaperones.

I, the parent of the youth, allow my child to participate.