YDAT Lock-in flyer 10.indd

10TH ANNUAL
YDAT
Youth Doing Awesome Things Lock-in
Through the Years
sponsored by the Mayor’s Youth Leaders in Action
Check-in begins @ 9:30 pm Friday
Doors close @ 10 pm sharp!
Be a part of this all-night event, and learn how smart decision-making can
lead to a bright future!
Register by March 19 at any
Virginia Beach Recreation Center.
Registration form on back.
Membership cards not required.
This year’s theme is “Through the Years”
• Haunted Truth
• Hard Luck Cafe
• Exciting workshops
• Guest speaker: Dr. Adolph Brown, Wellness international, LLC
YDAT10 partners:
Cinema Café
Kempsville Family Skating Center
Krispy Kreme
Jungle Golf
Pinboys
Pepsi
For details call 385-0428 (TTY: dial 711)
VBgov.com/parks • [email protected]
Virginia Beach Parks and Recreation is accredited
by CAPRA, the certifying agency of the
National Recreation and Park Association.
Plus fun activities!
• Dodgeball, wallyball, video games
& team-building activities
• Swimming – bring your bathing
suit and towel!
• Sports equipment provided
NO SLEEPiNG!
Food & refreshments provided
Music, prizes & giveaways!
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Hampton Roads Squadron
Naval Aviation Memorial
YOUTH OPPORTUNITIES OFFICE
March 26 & 27 • 9:30 pm - 7 am • Kempsville Recreation Center • $5
10th annual YDAT Registration Form
Lock-in for Middle School Students
Location
Class #94874
Friday, March 26 – Saturday, March 27
9:30 pm - 7 am
Register by Friday, March 19
Kempsville Recreation Center
800 Monmouth Lane, 23464
474-8492
Participants are randomly placed in groups. All group placements are final. Limit is 140.
No sleeping equipment needed • Sports equipment provided
Submit this form with $5
payment at any Virginia Beach
Community Recreation Center.
Participant’s Information
Name
D.O.B.
Address
Home Phone
Emergency Contact
School
Grade
Phone
Parent/Guardian Information
Name of Parent/Guardian Picking Up Participant
Address (If different than above)
Home Phone
Cell Phone
Medical Information
List Participant’s Medical Problems
Known Allergies
List Any Special Accommodations, Activity Considerations
Participant’s Physician
Phone
I am aware of the possibility of accidental or other physical injury, which may befall my child,
during the use of equipment and/or participation in programs conducted. I do hereby assume the risk of possible accidental physical injuries that my child may suffer while utilizing the City of Virginia Beach facilities and/or programs, and release from any and all
liabilities or cause of action the City of Virginia Beach, its employees and volunteers. This release shall be null and void for injuries
resulting from sole gross negligence of the City of Virginia Beach, its employees or volunteers. I hereby provide my consent for the
Department of Parks and Recreation to use photographs and/or interviews with me and/or my child(ren) in connection with publicizing or promoting the City of Virginia Beach, its services, or departments and agencies. I understand that there is to be no remuneration for this use or reproduction of said photographs.
Participant’s Signature
Date
Parent/Guardian’s Signature
Date