Parents Night Out Registration Form 2018
Adult and Youth Volunteers will lead fun activities and at the end of the evening watch a movie with kiddos in 5th grade and under while parents/guardians take some time away. Join us May 18th from 6-9pm. Please have dinner before arriving. A snack will be provided. Cost is $20 per child for the night. All proceeds will go toward the LOGOS Colorado trip this summer.
Child 1's Name *
Your answer
Birth Date *
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Grade
Your answer
Allergies and/or Health/Ed Concerns *
Your answer
Child 2's Name
Your answer
Birth date
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Grade
Your answer
Allergies and/or Health/Ed Concerns
Your answer
Child 3's Name
Your answer
Birth Date
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Grade
Your answer
Allergies and/or Health/Ed Concerns
Your answer
Parent/Guardian Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Address *
Your answer
I authorize SPUMC to take and use pictures/videos of my child in publicity for church programs and ministries.
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Emergency Contact Person during the Event. Name and Phone Number. *
Your answer
In an event of illness or accident, and if the parent/guardian can not be reached, I authorize Sun Prairie United Methodist Church or its agent to transfer my child to the hospital. My electronic notation on this form authorizes church leaders to consent to any emergency diagnosis, examination, treatment, or hospital care for my child who is deemed advisable by and is of an accident or illness in connection with any authorized church activities. I will assume responsibility for all medical expenses incurred on behalf of my child.
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Hospital *
Your answer
Physician *
Your answer
Physician Phone Number *
Your answer
Please list any other information below that you feel event organizers need to know about caring for your child.
Your answer
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