Parent's Night Out Registration Form

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All are invited to join the fun on Friday, December 19 from 5:30-7:30 pm in the Duncan FLC for Parent's Night Out! Grown-ups can drop off their kiddos and spend the evening running errands, doing last minute Christmas shopping, or enjoy a relaxing night off. Dinner, snacks, and activity supplies will be included in the $5 registration fee.

Please submit a new registration form for each child.

For more questions about PNO, please call the church office at 817-284-9371 or email macy@citypointumc.org.

Parent/Guardian's First and Last Name *

Parent/Guardian's Phone Number *

Parent/Guardian's Email Address *

Child's First and Last Name *

What name or nickname does your child usually go by?

Child's Gender *

Child's Birthdate

Parent's Night Out is offered only to children grades K-6.

YYYY

Does your child have any allergies or dietary restrictions?

Does your child have any special needs or medical accommodations?

Emergency Contact 1

Please provide the primary emergency contact's first and last name, phone number, and relationship to child.

Emergency Contact 2

Please provide the secondary emergency contact's first and last name, phone number, and relationship to child.

Media Permissions

I give my permission for my child's picture to be taken during Parent's Night Out at City Point United Methodist Church. Pictures may be used in City Point UMC print and digital media.

Yes, I give City Point UMC permission to photograph my child during PNO.

No, I do not give City Point UMC permission to photograph my child during PNO.

How would you like to pay the $5 registration fee for your child?

Tithe.ly Payment: Click Here

Zelle Payment: send to info@citypointumc.org

Cash payment at drop-off

Online payment through Tithe.ly - include Parent's Night Out in the notes

Online payment through Zelle - include Parent's Night Out in the notes

I would like to request a scholarship for my child.

Digital Signature & Statement

Please type your full name in the box below to act as your digital signature.

In case of an emergency and my child's emergency contact(s) cannot be located, I hereby give my authority and consent to medical treatment as may be needed in the judgment of the treating physician. I also authorize City Point UMC staff and/or volunteers to call 911 for transport in case of an emergency. I hereby release and discharge City Point UMC and its agents from any liabilities arising from my child's participation in VBS related activities. Please provide a digital signature by typing your full, legal name in the box below.

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