District Lock-In Student Registration
If you are an adult click this link: Adult Registration
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Email *
Student First & Last Name: *
I am a: *
I am a: *
What grade are you in? *
What church do you attend? *
Student's Phone Number: *
Does the Student have any allergies? *
Parents First & Last Name: *
Parents Phone Number: *
Parent Email: *

Participation Agreement

In consideration for the opportunity to participate in the NWIN Lock-In on April 12-13, 2024, the Participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to all locations during the  NWIN Lock-In The Participant (or parent/guardian) accepts personal financial responsibility for any injury sustained during the NWIN Lock-In or during transportation to and from the NWIN Lock-In. Further, the Participant (or parent/guardian) promises to indemnify, defend, and hold harmless the activities Sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as “Sponsor”) for any injury related directly or indirectly out of participation in the  NWIN Lock-In or transportation to and from the NWIN Lock-In, whether such injury arises our of the negligence of the Sponsor or otherwise. I agree to release and hold harmless any and all staff and lay assistants of the NWIN Youth Ministries and or its representative from any and all claims, suits, costs, and actions of any kind whatsoever, arising from their exercise of the power granted by this authorization, unless due to verifiable negligence.

If a dispute over this agreement or any claim for damages arises the Participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution.

Student/Parent Statement of Understanding

I understand that the following items/activities are prohibited and will result in the immediate dismissal from the  NWIN Lock-In without refund and at the cost of my parents/guardians. *alcohol *tobacco/drugs *pornography *profanity *weapons *fireworks *fighting *going into the opposite sex’s facilities *inappropriate attire/displays of affection. Cost of transportations home will be paid by the parent/guardian signing below.

This release is in effect April 12-13, 2024.
BY typing my FULL NAME below, I am agreeing to the above consent. *
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