Parent's Night Out
Central Valley Baptist Church
December 1, 2017
5:00PM - 9:00PM
600 N. Ten Mile Rd. Meridian, ID 83642
Contact us at (208) 888-4189 or office@centralvalleybaptist.com
Registration Information
The Student Ministry will care for your children, ages birth through 5th grade, and any special needs participants. There will be inflatables, games, pizza dinner and much more. There is no cost for this event.
Child's First and Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Child's Age or Current Grade *
Allergies or medical conditions we need to be aware of
Your answer
Parent / Guardian Name(s) *
Your answer
Parent / Guardian Phone(s) *
Your answer
Address (please include city and zip) *
Your answer
Email *
Your answer
Church your family attends (if any)
Your answer
Person(s) authorized to pick up child (other than listed above)
Your answer
Emergency Contact
Your answer
Emergency Contact Phone
Your answer
Emergency Medical Release
By entering my name below and as a parent/guardian of the above child, I do hereby authorize treatment by a qualified and licensed medical doctor 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 contact me.
Name of Parent/Guardian *
Your answer
Date *
Your answer
Submit
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