Kids Night Out: Weird Animals Registration
Stevens Road Baptist Church | 2 Stevens Rd., Dartmouth | srubcfamily@gmail.com | 902-435-1456
Important Information
Kids will understand that Jesus' love is one-of-a-kind.

Music | Games | Bible Stories | Crafts | Snacks

Please register each child individually.
Gr. 1 - 5 | 6 - 8pm

Day 1 July 8
Day 2 July 15
Day 3 July 29
Day 4 Aug 12
Day 5 Aug 19
Celebration Sunday, Aug 18, 10am

Cost: Free
Where: Stevens Road Baptist Church, 2 Stevens Rd., Dartmouth
Contact us at (902) 435-1456 or pastorerin@stevensroadbaptist.ca

Child's Information
Child's First Name *
Your answer
Child's Last Name *
Your answer
Please select all evenings your child will attend *
This helps us with planning for crafts and snacks
What Grade is your child entering in September? *
If your child is going into Gr. 6 in September he or she is still welcome to join us.
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Information
Parent First Name *
Your answer
Parent Last Name *
Your answer
Address *
Street, City, Postal Code
Your answer
E-Mail *
Your answer
Phone Number *
Your answer
Cell phone Number *
Your answer
Emergency Contact Information *
Full Name, relation to child, and phone number
Your answer
Who will be picking up your child? *
If other then parent/guardian listed above, please notify a KNO leader who will be picking up child.
Your answer
Do you have a Home Church? *
Required
If yes, where is your home church? *
Your answer
Photos and video's will be taken throughout KNO. I hereby state that I grant permission for pictures and/or video of my son/daughter to be used in promotional material for Stevens Road Baptist Church use in promotional material and updates. *
How did you hear about Kids Night Out: Weird Animals? *
I understand that upon bringing my child to KNO: Weird Animals the person dropping off and picking up my child will sign him or her in and out each night. *
This is to ensure the safety of the child and also for us to get to know parents and/or guardians of the children. Please use the "main" door closest to Stevens Rd for drop off and pick up.
The above registration form was read and completed by: *
Parent/Guardian Name
Your answer
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