Home › Elevate Lock-In RegistrationElevate Lock-In Registration Elevate Lock-In Student Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country School*Birthdate Grade*6th7th8thGenderMaleFemaleParent/Guardian #1 Name* First Last Parent/Guardian #1 Phone*Parent/Guardian #1 Email* Parent/Guardian #2 Name First Last Parent/Guardian #2 PhoneOther Emergency Contact Name First Last Other Emergency Contact PhoneAllergies/Dietary RestrictionsMedical InfoRemember, if you have any illnesses such as asthma, please bring extra medication. Please enter any information about allergies, meds, etc., below:Release & ConsentPlease note: You are NOT required to agree to the photography release for your child to attend. However, you MUST agree (which is the digital equivalent of your signature) to the Parental Consent in order for your child to be able to attend this lock-in. You will not be able to complete this registration unless you do.Photo/Video Release*I give permission to employees & representatives of Fellowship North to take photos/video of my child at the lock-in. I authorize the use of such photos/video to publish in print and/or electronically. I agree that Fellowship North may use such photographs with or without my child's name and for any lawful purpose, such as publicity, illustration, advertising, and web content.AgreeDisagreeParental/Guardian Consent*I give permission for any medical attention necessary to be administered to my child in the event of an accident, injury, sickness, etc., until such time as I may be contacted. I also assume the responsibility for payment of any and all such treatment, and release Fellowship North and it’s sponsors/employees against any claim by the registrant. I understand that if my child fails to comply by camp rules or displays inappropriate conduct that I will be contacted and will be responsible for their early return home.AgreeDisagree$5 for Lock-in (bring a 2-liter + snack to share!)* Price: $5.00 Total $0.00 This page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.