Parent’s Night Out
Parent’s Names? *
Your answer
What is your address? *
Your answer
What is your cell phone number? *
Your answer
What is your email? *
Your answer
1st child's full name and age. *
Your answer
2nd child's full name and age.
Your answer
3rd child's full name and age.
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Is anyone authorized to pick up your child(ren)? *
Name and phone number of authorized person.
Your answer
Dietary restrictions or severe allergies/ other info we need to know?
Your answer
Consent for Medical Treatment: Do you give the Acworth Church consent to treat your child(ren) medically, if necessary? *
Photo Release Waiver: I give my permission for the Acworth Church to use my child(ren’s) photo on the website or social media platforms to record or celebrate this event. *
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