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Kid's Night Out at Tuscola United Methodist Church
December 13, 2019
901 North Prairie St, Tuscola, IL 61953
5:30pm-10:30pm
Ages 4-12

ONE FORM IS TO BE FILLED OUT PER CHILD TO ATTEND THIS EVENT!
Child Full Name *
Your answer
Has your child attended KNO at TUMC previously? If no, please fill out the remainder of this form completely. If yes, you may jump down and submit this form. *
Child Age
Your answer
Child Birthday
MM
/
DD
/
YYYY
Last Grade Completed
Allergies, Medical Issues or Special Needs
Your answer
Dinner and a snack will be served during this event. Does your child have any dietary restrictions?
Parent Full Name
Your answer
Parent/Guardian Name and Phone Number
Your answer
2nd Parent/Guardian Name and Phone Number
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Parent Email
Your answer
Emergency Contact #1 (must include full name, and phone number)
Your answer
Emergency Contact #2 (must include full name, and phone number)
Your answer
Emergency Contact #3 (must include full name, and phone number)
Your answer
I understand that I must list anyone who may pickup my child on this form. If I am unavailable to pick up my child and the pickup person is not listed on this form, I will call and give verbal instructions to Kaylee as to who will be picking my child up.
Name (first and last) of anyone besides parent(s) listed above who may pickup my child. A valid ID must be presented upon pickup.
Your answer
Home Church (if applicable)
Your answer
Photo Release: I hereby grant the above named church permission to copyright and use photographs/videos taken at KNO of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Medical Release: I give my permission for the KNO staff and volunteers to administer basic first aid to my child in the event of an injury. I understand that the KNO staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.
I understand that I will have to pay upon arrival. The fee is $6 per child. Discounts are available for children with 4 or more children per family. The church will only accept cash and check. *
Required
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