ACTIVITIES *Swimming

*Climbing Wall

*Bungee Joust Combo

*Dance (DJ Dylan)

*Photo Booth

*Human Hamster Balls

*Inflatable Twister

*Hungry Hippos

*Soda Ring Toss

*Silly String Challenge

For Area kids CURRENTLY in 5th – 8th grade

$12/res. $19.50/NR pre-registration by May 11… $15/$22.50 day of event

Pre-register by returning your signed

permission slip to: The Hartford Recreation Center

125 North Rural St. (262)670-3730 Pre-registration during OFFICE HOURS ONLY is REQUESTED,

but not REQUIRED!!

16th Annual LOCK-IN Sponsored by: •The Hartford Parks & Recreation Department

Student’s Name______________________________________________Current Grade_________Email Address _________________________________ Address______________________________________________________________________Home Phone_____________________________________ Emergency Contact_________________________________________________________ Emergency Phone____________________________________

D.O.B. _____________ Age: ______ Gender: ____________ I hereby give permission for my child to attend the 2017 Teen Lock-In on Friday, May 12, 2017. I have discussed the rules with my child and understand that I will be called and expected to pick him/her up early, with no refund, in the event he/she does not follow the rules. I understand that no food, drink, alcohol, cigarettes or items of this nature are to be brought in. Any items brought will be subject to search. LIABILITY WAIVER: All registrants are required to sign the following release. Parents or guardians must sign for minors. I the undersigned do hereby agree; or agree for the above named registrant for whom I am the parent or guardian, to participate in the activity indicated and am aware of the understand that there may be risks and hazards inherent with participants in this activity. I affirm that I, or the minor registered for this activity, am doing so as a voluntary participant. In consideration of my participation or participation of the minor I do hereby agree to release, waive, absolve, indemnity on behalf of myself or minor, my/his/her family, my/his/hers heirs and my/his/her assigns the City of Hartford, its employees, officers, agents and sponsors from liability for injury, death or loss suffered by me or the minor in any and all present and future claims, liabilities, damages or right of action directly or indirectly resulting out of participation in the activity, using the liability for injury, death or loss suffered by my or the minor in any and all present and future claims, liabilities, damages or right of action directly or indirectly resulting out of participation in the activity, using the facilities, or engaging in any activities incidental thereto during the duration of the scheduled program which result from the ordinary negligence for the City of Hartford, its employees, officers, agents and sponsors. The city of Hartford does not provide accident insurance to participants in recreational activities and I assume full responsibility for any and all injuries or damages which may occur to me/my child while participating. MEDICAL EMERGENCY RELEASE WAIVER FOR MINORS: In the event of a medical emergency, I authorize the Parks and Recreation Department Staff to obtain medical treatment for my son/daughter or minor for which I am guardian.

Parent/Guardian:_________________________________________________________________

Registration Forms will NOT be accepted during office hours on FRIDAY MAY 12

MUST PRE-REGISTER BY

MAY 11!

The Richfield School District allows approved organization to distribute information for parents and students.

The opinions and/or views expressed in this information are not necessarily those of the School District or its personnel.

DOOR PRIZES

*Samsung Galaxy Tab

*

CHANCE TO WIN….

Antonio Brown Autograph Photo

*Green Bay Packers Autographed

Football

*Wave Tickets

*Admiral Tickets

And more!

Play most activities & games free one time with admission. Additional

plays of activities & games can be purchased. The St. Aidan Mission Trip

Group will be sponsoring the concession stand that will be open all

night offering snacks, soda, candy & Pizza!

Hartford Lions Club

Note to parents: By signing the permission slip, you and your child are agreeing to follow the drug and alcohol free policy.

Failure to follow this policy will result in intervention by the Hartford Police Department. Any items brought to the Lock-In may be subject to search. If you have any questions or if

you would like to help chaperone, please fill out the slip below or call Anita @ 262-384-0056, or Randy Wojtasiak at the Hartford Recreation Department at 262-

670-3730.

LOCK-IN RULES

1) Horseplay, misuse of equipment, being disrespectful, obscene language, vandalism, theft, inappropriate dress, or fighting will not be tolerated. Parents will be called immedi-ately and the students sent home. Any damages will be charged to the student. 2) Absolutely no food or drink may be brought in. These types of items will be confiscated. 3) Students must remain in the building unless participating in outdoor activities. 4) Students must follow the rules of the building at all times. 5) Do not bring any unnecessary valuables to the Lock-In. 6) Students must arrive by 5:30 PM and stay until 10:00 PM. If a student has to arrive late or can not stay until 10:00 PM, a note from a parent stating the reason for arriving late or leaving early (also list time has to leave) must be included with the permission slip and the parent must also sign-in or sign-out their child at the entrance. All teens must be picked up NO LATER than 10:00 PM.

LOCK-IN PARENT CHAPERONE SLIP

If you are interested in chaperoning – please either: fill out this slip & return to the Hartford Parks & Recreation Department, 125 N. Rural St., or call Anita at 262-384-0056 or Randy at 262-670-3730 to indicate the time you can help. If you fill out

this slip or call to chaperone – we are counting on you so please plan on showing up at the time you selected below. One Chaperone (16 and older) will get youth in for half price and two allows them to enter for free.

YES, I am available to chaperone the Lock-In at the following time (please check one).

4:30 PM – 8:00 PM 7:30 PM – 10:15 PM 4:30 PM – 10:15 PM

NAME(S)_____________________________________________________________PHONE_______________________________

ADDRESS____________________________________________________________________email___________________________

STUDENT CHAPERONING FOR________________________________________________________________________________