Parent's Night Out
When: February 15, 2019
Where: Liberty Community Church 11775 Morgansburg Rd Bealeton, VA 22712
Time: 6pm-10pm
Ages: children up to 5th grade
Cost:$2 donation to help cover the cost of your child(ren)'s meal
Email address *
Parents' Names *
Your answer
Phone number(s) you can be reached at. *
Your answer
Emergency Contact(s) -Names and Phone Numbers *
Your answer
Address *
Your answer
Please list the names & ages of all children you are registering. *
Your answer
Child(ren)'s Date(s) of Birth *
Your answer
Are your children potty-trained?
Additional Comments:
Your answer
I give permission for my child(ren) to participate in Liberty Community Church's Parents' Night Out event on February 15, 2019. I have no knowledge of any physical impairment that would affect my child(ren) from participating in the event. Upon signing, I agree that in case of accident while participating in the Parents' Night Out event, I release Liberty Community Church and it's volunteers from any liability. *
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