Overnight Shut-In

Name: Overnight Shut-In
Start: 2026-10-23T18:30:00-04:00
End: 2026-10-24T12:00:00-04:00
Location: Christ Baptist Church Burlington NJ

October 23 @ 6:30 pm - October 24 @ 12:00 pm

WHEN: Friday, October 23 to Saturday, October 24, 2026
WHERE: Christ Baptist Church
WHO: Ages 10 to 17

Additional Information

Dinner and breakfast will be served. Activities include video games, board games, prayer, and worship, among others.

Please bring a sleeping bag/blanket/pillow along with your nighttime materials (PJs, toiletries, etc.)

The child and/or parent MUST be a member of Christ Baptist Church to attend the shut-in event.

Email Birth registering?

Parent/Guardian Information

Parent/Guardian Name *

First

Last

Parent/Guardian Number *

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

How many children are you registering? *

Are you and/or your child(ren) a member of Christ Baptist Church? *

If you selected NO, your child(ren) cannot attend the retreat.

Child's Information & Medical Information

Name *

First

Last

Date of Birth *

Grade *

Gender *

Age *

Must be 8 years old or older

Medical conditions? *

Does your child have any known allergies? *

If Yes, please list known allergies.

Any specific dietary requirements? *

Current Medications (if applicable)

Special Instructions

Emergency Contact Information

Name *

Number *

Relationship to Child *

Consent, Agreement & Authorization

I, the undersigned, am the parent/legal guardian of the child named above. I give my full consent for my child to participate in the event specified.

Liability Waiver *

My family and I hereby waive and release the Christ Baptist Church, its Pastor, officers, employees, volunteers, or other representatives from all claims for damages and/ or injuries incurred while participating in or as a spectator at a Christ Baptist Church sponsored activity. I have read and understand the registration policies. Registration is invalid without signature.

Waiver and Release of Liability

Medical Treatment *

I understand that I will be notified at once in case of illness or accident involving my child, and I will make arrangements for medical care of my child with the physicians or hospital of my choice. If I cannot be reached to make neccessary arrangements or in a critical emergency requiring medicial treatment, I hereby authorize Christ Baptist Church/ Vacation Bible School to contact Emergency Medicial Services for transport to an emergency care facility. I understand that emergency personnel may choose to contact my child's physician listed below:

Field #41 (copy) *

By applying my electronic signature to this agreement, I agree that my electronic signature is the legally binding equivalent of my handwritten signature on paper. I will not, at any future time, claim that my electronic signature is not legally binding or enforceable. By electronically signing and submitting this agreement, I 1) acknowledge that I have read and fully understand the terms of the agreement; 2) voluntarily agree to be bound by this agreement; and 3) certify that I am 18 years of age or older. My signature applies to all pages of this contract. I understand that if I wish to sign a hard copy of this agreement instead of an electronic version, I must contact the party that requires my signature on this agreement directly. A parent or legal guardian must sign this agreement on behalf of any minor participant under the age of 18. By electronically signing this agreement, I represent that I have the authority to sign and enter into this agreement on behalf of the minor(s) listed above.

Signature: PRINT NAME BELOW to sign release *

Details

Start: October 23 @ 6:30 pm
End: October 24 @ 12:00 pm
Event Categories: 8:28 EVENTS, JAMM

Organizer

Christ Baptist Church

Venue

Christ Baptist Church Burlington NJ
950 Jacksonville Road
Burlington, NJ 08016 United States + Google Map
Phone (609) 387-1234
View Venue Website

Overnight Shut-In

WHEN: Friday, October 23 to Saturday, October 24, 2026 WHERE: Christ Baptist Church WHO: Ages 10 to 17