Youth All Nighter

Friday, October 237:00 PM–7:00 AM Saturday

Resurrection322 Ohio Street · Racine, WI

Register by October 20Permission slip required

Games · Food · FriendsBring a friend!

Sleeping bag and pillow—if you plan to sleep
Comfortable clothes, pajamas, and toiletries
Any needed medication, clearly labeled

Parent or guardian form

Permission slip

Please complete one form for each young person attending. The information below helps our leaders keep everyone safe and contact you if needed.

Required field

Participant

Participant’s full name *

Age *

Parent or guardian

Parent/guardian full name *

Email *

Mobile phone *

Emergency contact

Contact name *

Contact phone *

Relationship to participant *

Health and care information

Allergies, medical conditions, dietary needs, or other care information

Medications and instructions

Pickup authorization

People authorized to pick up this participant *

Permission and emergency authorization

I give permission for the participant named above to attend and take part in the Resurrection Youth All Nighter, including supervised games, food, group activities, and fellowship. I understand that reasonable safety precautions will be taken. If I cannot be reached in an emergency, I authorize event leaders to obtain necessary medical care for the participant, and I accept responsibility for expenses not covered by insurance. I understand that participants must follow event rules, respect leaders and others, remain on the premises unless released to an authorized adult, and avoid prohibited items or substances. I may be asked to pick up the participant if these expectations are not followed.

I have read and agree to the permission and emergency authorization above. *

Parent/guardian signature (type full name) * Typing your full name serves as your electronic signature.

Date signed *

Participant agreement

I agree to follow event rules, respect others and their belongings, remain with the group, and follow the directions of adult leaders.

Participant signature (type full name) *

Please submit by October 20.

By submitting, you understand that this form’s information will be emailed to pastorryan@lcrracine.org for event administration.