Youth Lock-In

Please fill out this form and click submit to allow your student to participate in the Lock-In.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Payment

1 Student to the Lock-In ($25.00) 1 Lock-In Scholarship Needed ($0) 1 Student Six Flags Only ($25) 1 Student Six Flags Only - Scholarship Needed ($0) 1 Student to Six Flags & the Lock-In ($50) 1 Student Scholarship for Lock-In & Six Flags ($0)

Amount

I give permission for my child to participate in the Lock-in and/or Six Flags event for North Pointe Church on August 5th. I understand they will be traveling for an activity and agree to give my permission for this.

*

Unnamed Label

*

Please select one option.

Yes, I agree No I don't agree

Agree

*

Please select one option.

Option Option Option

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit to allow your student to participate in the Lock-In.

Please Fix the Following

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