Parent's Night Out 2019 Registration Form
Thank you for registering your child to participate in 2019's Parent's Night Out Children's Service. We are so honored to be able to provide an exciting and fun service for your child while you get some much needed time to yourself. Please take a moment to register your child below. We will be serving a light snack so you may want to ensure your child has dinner before attending.
Name, Ages, and Grade of Children. Children age 3 through 5th grade only. (For those still in Preschool write PreK for grade) *
Your answer
Parent's Name *
Your answer
Parent's Cell *
Your answer
Parent's Email *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Email *
Your answer
Does your child have allergies. If so, list them below.
Your answer
Does your child have any special needs. If so, please explain below. You will be contacted by a ministry staff member to assess if we are able to accommodate you.
Your answer
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