HVUUC Youth Lock-In Registration 2026

Youth First Name*

Youth Last Name*

Grade*

Birth Date*

Date

Is your youth currently enrolled in the Stellar Sex Health class?

YesNo

Will your youth attend the Stellar Sex Health class on May 16 (4:15–5:30pm)?

YesNo

Will a parent/guardian attend the final Stellar Sex Health class & celebration on May 17?

YesNoNot sure yet

How long will your youth be staying?*

Full Lock-In (overnight May 16–17)Partial — Pickup late evening May 16Stellar Class Only

Dietary needs, restrictions, or allergies

Anything else we should know to help your youth feel comfortable and supported?

Guardian First Name*

Guardian Last Name*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email Address*

example@example.com

Emergency Contact Full Name*

Emergency Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Permission Statement:

I give permission for my youth to participate in the HVUUC Youth Lock-In (May 16–17, 2026). I understand that this event includes supervised overnight participation, activities, and meals.

I authorize HVUUC staff and volunteers to provide basic first aid and over-the-counter medications (such as Tylenol or ibuprofen) if needed.

In the event of a medical emergency, I understand that:

The parent/guardian listed above will be contacted first.

The emergency contact listed will be contacted second.

Emergency services (911) may be contacted immediately if the situation requires urgent care.

I confirm that I have provided accurate and complete information to the best of my knowledge.

Permission & Agreement*

I, the parent/guardian named on this form, have read, and agree to the Permission & Agreement statement above.