Lock-In 2025

Participant First Name REQUIRED Please fill out this field. Please enter valid data.

Participant Last Name REQUIRED Please fill out this field. Please enter valid data.

Participant Birth Date REQUIRED Please fill out this field. Please enter a date.

Participant Email Address REQUIRED Please fill out this field. Please enter an email address.

Gender REQUIRED Male Female Please fill out this field.

Grade REQUIRED 9 10 11 12 Please fill out this field.

Please note anyone who signs up after February 2nd is not guaranteed a shirt.

T-Shirt Size REQUIRED Please fill out this field.

Parent First Name REQUIRED Please fill out this field. Please enter valid data.

Parent Last Name REQUIRED Please fill out this field. Please enter valid data.

Parent's Email Address REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact Name (Must be different from parent listed above.) REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone REQUIRED Please fill out this field. Please enter an email address.

Electronic Signature

By selecting the "I agree" button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting "I agree" using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor's parent or legal guardian.

I Agree Please select this field.

Permission to attend

I, the parent or guardian of above mentioned child, give permission for my child to participate in the OLPH Spring Lock-In on February 28-March 1, 2025.

I Agree Please select this field.

Hold Harmless

In the event of any injury or illness to my child during his/her participation in this program, I hereby give my permission for necessary medical treatment to be given to my child. I agree that in case of injury to my child, we will apply my hospitalization and/or or accident insurance toward payment of the expenses incurred and will not look to OLPH or any other program sponsor or volunteer for the payment of any medical costs or injury-related costs.

I Agree Please select this field.

Consent to Treat

I, the undersigned parent/guardian of the above named child do hereby authorize treatment of my child by a licensed medical physician in case of any accident or illness that may so arise, or any hospitalization necessary. This medical consent will remain effective until Saturday, March 1, 2025 at 11:59pm.

I Agree Please select this field.

Please select the following in accordance with your wishes as parent/guardian:

Consent to Administer Medication (s) My child is TAKING MEDICATION AT PRESENT. My child will bring all such medications necessary, and such medications will be well labeled. I grant PERMISSION FOR NON-PRESCRIPTION MEDICATION (Tylenol, throat lozenges, cough syrup) to be given to my child if deemed advisable. NO MEDICATION of any type, whether prescription or non-prescription may be administered to my child unless the situation is life-threatening.

Please list any special dietary needs or restrictions

Known Allergies:

Cost50.0

Our Lady of Perpetual help

St. Mary of the Assumption &
St. Ursula Churches

Lock-In 2025

Spring Lock-In 2025

Teen Registration

Registration closes February 14, 2025