Parent's Night Out
Living Gospel Baptist Church
23 W. Passaic Ave,
Rutherford, NJ 07070

Friday, January 11 6pm-9pm

Need an evening without the kids? Our parent’s night out program gives parents the opportunity to take a well-deserved break. Go out for a night on the town feeling confident that your children are safe and having the time of their lives’. Children ages birth through 13 years old are welcomed. During the evening, we will enjoy dinner, games, crafts, recreation, and a movie. Parents’ Night Out begins at 6pm and lasts till 9pm. This is a drop-in program, but feel free to pick up your child whenever you are ready. It is NOT mandatory that your child needs to stay till 9pm.

*We will serve dinner during this event. If your child has any dietary restrictions please let us know.

Child's name *
Enter the child's first and last name
Your answer
Child's age *
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Sex *
Does your child have any allergies or medical issues that we need to be aware of?
Your answer
Does your child have any dietary restrictions? If so, please specify.
Your answer
Parent/Guardian's name *
List the name of the parent or guardian of the child to be registered.
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Parent's email *
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Parent's phone number *
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Address *
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Emergency contact info *
Include name and phone number. This is for if we can't reach the parent.
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Please list ALL people (including parents) who are authorized to pick up your child: *
Only people on this list will be able to pick up your child. Be sure to list yourself if you intend to pick up the child.
Your answer
Do you have a church that you regularly attend?
If so, which church?
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