FBYouth Lock-In 2026

FIRSTBAPTIST.FREMONT
505 N C Street
Fremont | NE | 68025
402-721-1265
Activity Consent Form
Youth Lock-In | Partnering with Benson Baptist Church & First Baptist Omaha
Location: First Baptist Omaha, 421 Park Ave, Omaha, NE
Dates/Times: April 24^th @ 7p - April 25^th @ 7a
Drop-off: April 24 at 6:00 PM @ First Baptist.Fremont
Pick-up: April 25 at 8:00 AM @ First Baptist.Fremont
Who: Students in Grades 7-12
Contact person(s) for the activity
earnold@omahafbc.org
Jesse Kracht - (FBYouth Leader) 402-689-2878
STUDENT INFORMATION
Student Name:*
Grade*
Date of Birth:*

MonthDayYear
Date
STUDENT INFORMATION
Student Name:
Grade
Date of Birth:

MonthDayYear
Date
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name:*
Phone Number:*
Format: (000) 000-0000.
Email:
example@example.com
Emergency Contact (if different): Emergency Phone:*
Format: (000) 000-0000.
MEDICAL INFORMATION
Please list any allergies, medical conditions, or special needs:
Medications (if any):
I give permission for my child to receive basic first aid. In the event of a medical emergency, I authorize leaders to seek medical treatment if I cannot be reached. Parent/Guardian Initials:*
LIABILITY RELEASE
I understand that participation in this event involves normal activities associated with a youth lock-in, including games, sports, and group activities. I release First Baptist Church of Fremont, Benson Baptist Church, First Baptist Omaha, and all leaders/volunteers from liability in case of accident or injury, except in cases of gross negligence. Parent/Guardian Initials:*
PHOTO / MEDIA RELEASE
I give permission for my child to be photographed or included in video during this event. These images may be used for church publications, social media, and promotional purposes.*

YesNo
Parent/Guardian Initials:*
PERMISSION
I give permission for my child to attend and be transported to the Youth Lock-In hosted in partnership with First Baptist Church of Fremont, Benson Baptist Church, and First Baptist Omaha.Parent/Guardian Signature:*
Relationship to Child:*
Date:*

MonthDayYear
Date
Should be Empty:

FIRSTBAPTIST.FREMONT

Activity Consent Form

STUDENT INFORMATION

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

MEDICAL INFORMATION

LIABILITY RELEASE

PHOTO / MEDIA RELEASE

PERMISSION