white stone student ministry 2019 whitestonestudents.com

WHITE STONE HIGH SCHOOL YG

WHEN? 7pm - 7am Friday, June 14th – Saturday, June 15th

WHERE? White Stone Community Church & Laser Tag Adventure

WHO? Any student in 9th, 10th, 11th, and 12th Grade for the 2018-19 school year

WHAT? This is an all-nighter at White Stone Community Church. We will be going to Laser Tag

Adventure from 8-11:00 (Waukesha), and then spending the rest of the time at White Stone playing games, watching movies, and having a great time! *To play Trampoline Dodgeball at Laser Tag Adventure, each student must have a waiver filled out by a parent/guardian! Go to: https://ltawaukesha.pfestore.com/waiver/ to fill it out for your student!

COST? $35 per student (Cost covers transportation to and from “Laser Tag Adventure”, Laser Tag, Trampoline Dodgeball, pizza and soda. Online payment is available at http://ow.ly/IevV30apQJW)

TIME?

Students should be dropped off at 7:00pm on Friday, and need to be picked up at 7:00am sharp on Saturday!

*Remember to get your permission/medical slips and money in to Jake ASAP!

Space IS LIMITED...once all the spots are filled, registration will be closed!

DEADLINE TO TURN EVERYTHING IN IS Sunday, June 2nd If you would like to write a check, please write it out to: WHITE STONE COMMUNITY CHURCH. Also, in the memo please put: STUDENT MINISTRY HIGH SCHOOL LOCK-IN If you have any questions, please call Jake at 262.569.2766.

what to bring: Sleeping Bag, Pillow, a fun board/card game, & appropriate pajamas

what NOT to bring: Don’t bring energy/coffee drinks, snapping turtles, or swords Reminder: Students are all responsible for their own possessions at the Lock-In!

white stone student ministry 2019 whitestonestudents.com

white stone student ministry 2019 whitestonestudents.com

HIGH SCHOOL LOCK-IN 2019 GUIDELINES

Please read the following guidelines with your student. You and your student need to sign the

guideline sheet and return it with your money, permission slip, and medical slip.

1. I agree to listen to and obey all adult leaders from White Stone Student Ministry and leaders from Laser

Tag Adventure.

2. I agree to not leave White Stone’s building unless in the case of an emergency.

3. I agree to give Jake Andrus all prescription medications with instructions.

4. I agree to stay out of the room of the opposite sex, otherwise I will be sent home.

5. I understand that I am responsible for everything I bring to the Lock-In.

6. I agree to have a fun time! If I am out of control, or break any of the above guidelines, I understand that

my parents will be called immediately and asked to pick me up from White Stone.

___________________________________ _______________

Student’s Signature Date

___________________________________ _______________

Parent’s Signature Date

WHITE STONE COMMUNITY CHURCH

2019 HIGH SCHOOL LOCK-IN PERMISSION SLIP

My son/daughter (name)_______________________, has my permission to go to the

(event)_______________________ on (date)_____________ with the White Stone

Community Church youth group. I also authorize transportation (approved by White

Stone) to and from “Laser Tag Adventure” in Waukesha.

I will also sign a medical authorization form before the event. I understand that my child cannot

attend any function that is off the church grounds without a signed authorization.

PARENT/GUARDIAN NAME (PRINT):______________________________________

PARENT/GUARDIAN (SIGN):______________________________DATE:_________

white stone student ministry 2019 whitestonestudents.com

MEDICAL AUTHORIZATION It is with my full knowledge and permission that my son/daughter/ward _______________________, participates in church sponsored

activities of White Stone Community Church, 2517 N. Dousman Rd., Oconomowoc, WI 53066 during the period commencing from

the date below. I hereby authorize Jake Andrus, the youth group leadership (as designated and empowered by White Stone

Community Church) to consent, on my behalf to such examination of my child by a licensed physician as is necessary to determine

the nature and extent of injuries or illness, including but not limited to the taking of x-rays and body fluids, and he/she is further

authorized to consent to such treatment as such physician determines to be reasonably necessary under the circumstances except for

those treatments, if any, listed below. I further authorize said person(s) to sign any consent forms required by any hospital as a

condition to the examination or treatment by a physician and /or duly recognized member of a hospital staff. I understand that

treatment may begin prior to my awareness of the situation, but I expect to be notified at the earliest time that is reasonable possible

under the circumstances.

EXCEPTIONS: __________________________________________________________________________________________

______________________________________________________

MEDICAL INSURANCE COMPANY

Name: ______________________________ Number: ___________________________

Parent/Guardian’s Signature: ____________________________ Date: _____________

Address: _______________________________________________________________

CONTACT INFO:

Main Phone: _________________________

Work Phone: _________________________

Main Email:______________________________________________

*Please indicate any pertinent medical information, such as allergies, contacts, medications taken, etc. on a

separate piece of paper (stapled to this page).