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
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
Date of Birth
Child's Age or Current Grade
3 Years Old
4 Years Old
5 Years Old
Special Needs Participant
Allergies or medical conditions we need to be aware of
Parent / Guardian Name(s)
Parent / Guardian Phone(s)
Address (please include city and zip)
Church your family attends (if any)
Person(s) authorized to pick up child (other than listed above)
Emergency Contact Phone
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
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