YA Hunger Games Lock-In Permission Form
YA Hunger Games Lock-In Permission Form
YA Hunger Games Lock-In Permission Form
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<strong>Hunger</strong> <strong>Games</strong> <strong>Lock</strong>-in<br />
March 16, 2012, 6 – 9 pm<br />
You must have the permission slip below signed by a parent/guardian and on file with the Young Adult<br />
Librarian before you may attend the lock-in. Please return the slip before 3/15/12. Slips will not be accepted<br />
the day of the event. You and a parent/guardian must sign the Teen Behavior Agreement on the back of the<br />
parent permission slip.<br />
Things to Bring:<br />
• Flashlight<br />
• Snacks/Drinks<br />
<strong>Permission</strong> Slip for Parent/Guardian to Sign<br />
My child has permission to be at the Lebanon Public Library <strong>Hunger</strong> <strong>Games</strong> <strong>Lock</strong>-in on March 16 th from 6 – 9<br />
pm. I agree to have prompt transportation for my child to and from the library for this event. This event will<br />
be chaperoned by Marie Brown, Young Adult Librarian, and other adult library volunteers. I understand that if<br />
my child is behaving in an inappropriate manner at any time during the lock-in, that I will be contacted and<br />
that I will be expected to transport my child from the lock-in immediately. Once my child arrives at the library,<br />
they will not be allowed to leave for any reason unless I pick them up. If they do leave the lock-in, they will<br />
not be allowed back. They cease to be the library’s responsibility once they leave the building.<br />
If for any reason you need to contact your child during the lock-in, you can call Marie Brown at 765-418-7399.<br />
The library’s phone will not be answered during the lock-in.<br />
I allow Lebanon Public Library to use photographic accounts of my child’s participation in the event for<br />
publicity in print and online.<br />
Teen Name (print) ______________________________ Teen Signature _____________________________<br />
Parent/Guardian Name (print) ____________________ Parent/Guardian Signature ____________________<br />
Relationship to child ________________<br />
Phone number to text future events information ___________________________________________<br />
Email for future events information ______________________________________________________<br />
Phone number where parent/guardian can be reached during the <strong>Lock</strong>-in ________________________<br />
Emergency contact in case parent/guardian can’t be reached (name and phone)<br />
_____________________________________________________________________________________<br />
Health concerns that Marie needs to know about ____________________________________________
Teen Behavior Agreement<br />
I agree to follow all library rules and regulations during the lock-in. I understand that there will be no<br />
tolerance for misbehavior during the lock-in and that if I misbehave; my parent/legal guardian will be called to<br />
pick me up from the lock-in. I understand that I will not be allowed to leave the library for any reason during<br />
the lock-in unless a parent comes to pick me up and that if I do leave the library building that I will not be<br />
allowed back in to the lock-in and that I will cease to be the responsibility of the library. I understand that<br />
Marie Brown, and the other adult library volunteers are the chaperones of the lock-in and that they will have<br />
final say on any behavior issues during the lock-in.<br />
I also allow Lebanon Public Library to use photographic accounts of my participation in the event for publicity<br />
in print and online.<br />
Teen name (print) _________________________________ (signature) _______________________________<br />
I have read and understood the above agreement.<br />
Parent name (print) ________________________________ (signature) _______________________________
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