Lock-In Form Examples

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July 28 th , 2011 Dear Parent, Your teen is invited to participate in the TAB (Teen Advisory Board) Lock-In at the La Vista Public Library. The Lock-In will take place from 5 p.m. Friday, August 12 th to 8 a.m. Saturday, August 13 th . We hope this event will be a unique and enjoyable experience for everyone. When your teen arrives for the Lock-In please make sure they have the following items that they will need during the night: Signed permission slip and rules of conduct slip in order to be admitted Comfortable clothing (pajamas, slippers, etc.) Telephone number where you can be reached if there is a problem during the night Pillow and sleeping bag to rest on (optional) Snacks to share with group (bag of chips, cookies, etc.) (optional, but welcome) On Friday, August 12 th teens may be dropped off at the library anytime until 5 p.m. when the library closes. For safety reasons no one will be admitted after that time. Teens will need to be picked up on Saturday, August 13 th no earlier than 8 a.m. Because most of the teens will be staying up all night everyone needs to be picked up. No one will be allowed to drive themselves home. The library will be providing snacks and drinks during the course of the evening. The main course for dinner will be pizza. Breakfast will also be provided. Participants are encouraged, but not required, to bring a snack to share, such as chips, cookies, or something for breakfast. If there is an emergency and you need to contact your child during the Lock-In, the telephone numbers to call are 402-403-0080 or 402-350-7543. These are the cell phone numbers for two of the supervising librarians. Please RSVP for the Lock-In by Friday, August 5 th You can do this by calling me, emailing me, or giving me the signed slips prior to the event. I need to know how many teens can make it and how many supplies to get, etc. If you have any questions please call Lindsey Tomsu, Teen Coordinator, at 402-537-3900 during normal library hours. I will be happy to answer any questions you may have. Thank you, Lindsey Tomsu Teen Coordinator

Transcript of Lock-In Form Examples

Page 1: Lock-In Form Examples

July 28th, 2011

Dear Parent,

Your teen is invited to participate in the TAB (Teen Advisory Board) Lock-In at the La Vista Public Library. The Lock-In will take place from 5 p.m. Friday, August 12th to 8 a.m. Saturday, August 13th. We hope this event will be a unique and enjoyable experience for everyone.

When your teen arrives for the Lock-In please make sure they have the following items that they will need during the night:

• Signed permission slip and rules of conduct slip in order to be admitted• Comfortable clothing (pajamas, slippers, etc.)• Telephone number where you can be reached if there is a problem during the night• Pillow and sleeping bag to rest on (optional)• Snacks to share with group (bag of chips, cookies, etc.) (optional, but welcome)

On Friday, August 12th teens may be dropped off at the library anytime until 5 p.m. when the library closes. For safety reasons no one will be admitted after that time. Teens will need to be picked up on Saturday, August 13th no earlier than 8 a.m.

Because most of the teens will be staying up all night everyone needs to be picked up. No one will be allowed to drive themselves home.

The library will be providing snacks and drinks during the course of the evening. The main course for dinner will be pizza. Breakfast will also be provided. Participants are encouraged, but not required, to bring a snack to share, such as chips, cookies, or something for breakfast.

If there is an emergency and you need to contact your child during the Lock-In, the telephone numbers to call are 402-403-0080 or 402-350-7543. These are the cell phone numbers for two of the supervising librarians.

Please RSVP for the Lock-In by Friday, August 5 th You can do this by calling me, emailing me, or giving me the signed slips prior to the event. I need to know how many teens can make it and how many supplies to get, etc.

If you have any questions please call Lindsey Tomsu, Teen Coordinator, at 402-537-3900 during normal library hours. I will be happy to answer any questions you may have.

Thank you,

Lindsey TomsuTeen Coordinator

Page 2: Lock-In Form Examples

LA VISTA PUBLIC LIBRARY LOCK-IN RULES AND REGULATIONS

The following rules will apply for the Teen Advisory Board Lock-In at La Vista Public Library on Friday, August 12th at 5 p.m. to Saturday, August 13th at 8 a.m.

• Teens will arrive before 5 p.m. on Friday, August 12th and leave at 8 a.m. on Saturday, August 13th.

• The library will be locked at closing time (5 p.m.) on Friday, August 12th and unlocked at opening time (8 a.m.) on Saturday morning. No one will be allowed to enter the library after 5 p.m.

• Except in a case of emergency or in the event they are asked to leave for violating the rules, no teens are allowed to leave once the event has begun.

• All teens who wish to attend must have a signed permission slip.

• No more than 20 teens will be allowed to attend the lock-in. • Teens must be a current school-year (2010-2011) Teen Advisory Board member to attend

and must be in sixth grade and up.

• There will be five (confirmed) adult librarian chaperones locked-in with the teens.

• Teens will have access to the whole public library floor. They will not be allowed out onto Metro’s campus.

• There will be no inappropriate behavior.

• Chaperones will remain with participants at all times.

• Everyone will remain in the library and within the designated lock-in areas at all times.

• There will be no visits from anyone not participating in the lock-in.

• All activities will be open to all participants. There will be no exclusive activities among lock-in participants.

• All movies shown will be rated PG or PG-13.

• All games (this includes board games and video games) that teens want to bring for the lock-in must be rated E or T and must include multi-player options.

• All participants will strictly abide by these rules and instructions given by the chaperones. Teens who do not abide by the rules will be given one warning. If a second offense is committed, the teen’s parent/guardian will be contacted and asked to pick up the teen. Until the teen can be picked up, they will be separated from the rest of the group and supervised by one of the chaperones.

• During the program, if you have an emergency and need to get a hold of your teen, you may contact Lindsey Tomsu on her cell phone: (402) 403-0080 or Gordon Wyant on his cell phone: (402) 350-7543.

Page 3: Lock-In Form Examples

RULES OF CONDUCT

You will not be allowed to exit and re-enter the program. Once you check in at the front door, you are to remain in the library until the end of the lock-in or in the case of an emergency.

The program ends at 8 a.m. on Saturday, August 13th. Please make sure that you are aware of the time the event ends. While noise level rules will be more relaxed, standard rules of library conduct still apply.

Rules of library conduct include but are not limited to:

• No noisy or disruptive behavior• No drugs or alcohol allowed• No threatening, offensive or abusive language and behavior• No harassment of librarians in charge or fellow teens• No misuse or defacement of library facility or materials• No violating any state, federal or local laws• No food or drink outside the large meeting room/storytime room• Everyone cleans up after themselves

I agree to comply with the rules for La Vista Public Library Teen Advisory Board Lock-In. I agree to listen to library staff. I understand that library employees are authorized to enforce these rules. The library reserves the right to revoke or restrict event privileges of any user for conduct contrary to these rules.

Printed name: _____________________________________________________________________________Signature: _____________________________________________________________________________Parent/Guardian Name & Contact Number: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Page 4: Lock-In Form Examples

La Vista Public Library Teen Advisory Board (TAB) Lock-InFriday, August 12th, 5 p.m. — Saturday, August 13th, 8 a.m.

(All teens MUST be in the library by 5 p.m. on Friday. Doors are shut for the night at 5 p.m.)

This form is your admission ticket to the lock-in. PLEASE return it to the library signed by your parent or guardian!

PLEASE RSVP by Friday, August 5 th !

To Bring: Pillow, blanket/sleeping bag, special foods/medications as needed, video games and system if desired (no rated M, please), board games, pajamas if desired, movies you may want to watch (PG-13 and below, please)

Not To Bring: Alcohol or other illegal substances, tobacco products, movies and/or video games with an adult rating

Planned activities:

• Board Games, Wii Games, Rock Band• Movies in the Large Meeting Room• Crafts and Gaming in the Storytime Room• Participation in the Children’s Stuffed Animal Sleepover (children bring their stuffed animals to the

library for a sleepover and the teens, during the night, will take pictures of the stuffed animals having fun in the library with no one around). Bring your own stuffed animal friend if you want!

• Snacks/Drinks will be available throughout the evening; breakfast will also be served

I, ______________________, authorize a staff representative to see that my child receives any emergency medical treatment that may become reasonably necessary while child is participating in this lock-in. I, or the insurance company providing coverage for my child, guarantee payment of all charges incurred for medical treatment.

My child has the following medical conditions. If none, state “None”: ________________________________________________________________________________________

Treatment for above _______________________________________________________________________

My child is allergic to the following medications. If none, state “None”:________________________________________________________________________________________

Check one:_____I do not have medical insurance to cover treatment.

_____I have medical insurance with company/provider name ________________________ Policy/Group number____________________

Parent/guardian home phone # _____________________ Mobile phone # _____________________

Emergency contact if parent/guardian cannot be reached:Name: ______________________________ Relationship: __________________________Home Phone: _________________________ Cell Phone: ___________________________

Parent/guardian signature: _____________________________________ Date: __________________