LOCK-IN TIME
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AUGUST 20TH LOCK-IN 

YOUR KIDS WILL LOVE IT!!! SAFE. FUN. AND THEY WILL WANT TO JOIN US ON WEDNESDAYS & SUNDAY

    LOCK-IN FORM

    After completing this form - feel free to call us with questions - KEVIN STALCUP, YOUTH DIRECTOR 706-835-9321 OR SUSAN STALCUP - 706-897-9222. 
    ​Names of all persons who are authorized to pick up your child, including parents and guardians should be listed here.  Proper picture identification may be required before a child is released.  Check in upon arrival and check out is required. 
    Registration & Liability Release Form 
    I, the parent or guardian, (HEREAFTER"I") have voluntarily elected to allow my child(ren), name(s) stated above (hereafter “child(ren)”) to participate in activities conducted at Youngstown Baptist Church LOCK-IN (hereafter “Event”) from AUGUST 20-21ST

    I hereby confirm that my child(ren) are in good physical condition and do not suffer from any disabilities or physical conditions that places him/her or others at risk or otherwise should prohibit their participation in the Event.
    I HEREBY WAIVE AND RELEASE, INDEMNIFY AND HOLD HARMLESS AND FOREVER DISCHARGE, Youngstown Baptist Church, and/or their agents, representatives, employees, volunteers, officers, directors, affiliates, and their respective heirs, representatives, and all persons, firms, corporations, whether or not herein named (hereafter “Released Parties”), from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, which I or my child(ren) may have or hereafter have, arising from or in any way relating to my child(ren)’s participation in any of the events or activities conducted by the Released Parties, on the premises of the Released Parties, or for the benefit of the Released Parties.
     
    I understand that the activities that my child(ren) may participate in are inherently dangerous and his/her/their participation may cause harm or grievous injuries, including bodily injury, damage to personal property and/or death.  I, on behalf of my child(ren), my spouse, heirs, executors, administrators, representatives, successors and assigns, and next of kin, hereby waive all claims for damages, injuries, and/or death sustained to my child(ren) or property that I may have against the aforementioned Released Parties to such Event.
     
    By this WAIVER AND RELEASE, I assume any risk, and take full responsibility of any and all claims of personal injury and death or damages to, including, but not limited to, my child(ren)’s use of the Released Parties’ facilities and/or engaging in the Released Parties’ activities or other activities during the Event or on or near the Released Parties’ premises.
     
    This WAIVER AND RELEASE contains the full and complete agreement between the Parties, the terms are contractual and not merely a recital and supersedes any and all prior written or oral agreements and representations between the Parties concerning the activities during the Event.  Any additions or changes to this WAIVER AND RELEASE shall be valid only if set forth in writing and signed by all the Parties. 
     
    Furthermore, this WAIVER AND RELEASE is binding upon the undersigned, and his/her spouse, heirs, next of kin, executors, administrators, representatives, successors and/or assigns. 
     
    This WAIVER AND RELEASE shall be subject to the laws of the State of Georgia. If any portion of this WAIVER AND RELEASE is held to be invalid, the balance hereof, notwithstanding such holding, shall remain in full force and effect.
     
    I acknowledge that I have read, understand, and fully agree to the terms of this WAIVER AND RELEASE and its contents.  I understand and confirm that by signing his WAIVER AND RELEASE I have given up considerable future legal rights.  I have signed this WAIVER AND RELEASE voluntarily, under no duress or threat of duress, without inducement, promise, or guarantee being communicated to me. 
     
    I hereby affirm that I am 18 years of age or older and mentally competent to enter into this WAIVER AND RELEASE.  I hereby affirm that I am signing as a parent or legal guardian of said child(ren). I represent that I have the full authority to do so, realizing that this release is binding upon the minor child(ren) as well as myself.
    Medical Release Form
    I, the parent of the child listed above hereby give permission for any and all medical attention to be administrated to my child in the event of accident, injury, sickness, etc. under the direction of the person(s) listed below, until such a time as I may be contacted. I also assume the responsibility for the payment of any such treatment, releasing DON ANDERSON, and/or Youngstown Baptist Church and/or its employees or agents of any responsibility or liability. This release is effective for the period of one year from the date given below.
    In case I cannot be reached, any representative of Youngstown Baptist Church Youth Camp can act on my behalf, including, but not limited to CPR, First Aid, transportation, and transfer of medical records to emergency facility if needed.