Thank you for your interest in our youth group event!

Upcoming Event:

Middle School Lock-in for grades 6-8: May 22-23, 7PM-7AM

Middle School Lockin 2026 1

"*" indicates required fields

Student's Name*

First Last

Date of Birth*

NOTE: this information will be kept confidential and only used in the case of an emergency hospital visit

Hospital Preference*

In the event of an emergency, please note the hospital you would prefer your student be taken to.

Gundersen/Emplify

Mayo

Either hospital above

Other

Food Allergies

Please note any known food allergies for your student.

Pertinent Health Conditions

Please note any health conditions, medicine allergies, medications, etc. that you would like our event leaders to know about.

Home Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian Name*

Parent Phone*

Parent Email