Great Date Escape Childcare Signup
Great Date Escape
Cornerstone Community Church
Saturday, December 2nd
5:00 - 9:00
Sign your kiddos up here if you need childcare for the Great Date Escape evening. Childcare is available from 5:00 - 9:00. This is a Polar Express Themed Event so wear your pjs and bring pillows and blankets!
Dinner and snacks will be available.
Name of Parent or Guardian *
Child #1 Name & Age *
Child #2 Name & Age
Child #3 Name & Age
Child #4 Name & Age
Approximate time your child(ren) would need care:
Email *
Phone number (to reach you that evening) *
Allergies or Important Health Concerns *
MINOR ACTIVITY PERMIT: As a parent and/or guardian, I do herewith authorize treatment under the direction of any licensed physician of the following minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me by phone provided during registration. The undersigned assumes the responsibility for any costs connected with such treatment and hereby releases the church where child attends Preschool Pathfinders from any liability. Date or dates when release is intended: September 1, 2017– May 31, 2018. This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence. *
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By checking this box, I am authorizing medical treatment under emergency circumstances in my absence.
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