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Student Name (First & Last)*

Parent's Name (First & Last)*

Child's Age*

Student's Grade*

Email*

Phone*

Check the box to signify that you understand that children participating in the Teen Lock-In should be picked up no later than 10pm.*

Check the box to signify that you understand that children participating in the Teen Lock-In should be picked up no later than 10pm.*

As parent/guardian, I hereby release Tyson Library from any and all liability, claims or causes of action that may arise from any accidents, injuries, or illness that may occur to my child for his/her participation in the library lock-in. I agree to take full responsibilty of any damagw my child may cause to library property while in attendance at this activity. Please, type your full name below in place of a signature.*

Reminds

Check the box if you would like to receive reminders and updates via text message for this program.

May we have your permission to use your child's name and/or picture for library marketing purposes, including in social media?*

Yes No

Please list any allergies/food intolerances.*

Address

If you are a human, do not fill in this field

Related Events

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  Teen DND

  April 24 @ 3:30 pm - 5:30 pm
• 

  Young Adult Book Club

  April 25 @ 3:30 pm - 4:30 pm
• 

  Young Adult Book Club

  May 23 @ 3:30 pm - 4:30 pm