Kids Night Out Registration
Please note that the information on this form is for the use of the youth leaders of Kids’ Night Out at West Falmouth Baptist Church and is not available to any other individuals or groups. This means that we will not disclose your e-mail address, mobile number or any other details to another individual without your permission.
Child's Name (Last, First) *
Your answer
Child's Date of Birth *
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DD
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Child's Mailing Address - Street: *
Your answer
Town: *
Your answer
State: *
Your answer
Zip Code: *
Your answer
Child's Gender *
Parent's Email Address *
Your answer
Emergency Contact - Name and Phone Number *
Your answer
Medical Information - list any allergies or relevant medical conditions
Your answer
Dietary Needs or Restrictions
Your answer
Kids’ Night Out maintains a Facebook page & events page at the WFBC website to promote Kids’ Night Out events. If you give permission for us to use images or video of your child to promote Kids’ Night Out, please check below:
Parent/Guardian Consent: "I agree to my son/daughter participating in Kids’ Night Out and the activities run by the team. I understand that every care will be taken to ensure the health, safety and welfare of my child. I realize and accept that in the event of my child’s behavior adversely affecting the safety of the activity, the organizers reserve the right to return my child home." *
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