Parent's Night Out Registration Form
Saturday, August 24 from 5:00-8:00pm
Child services provided at Messiah Lutheran for infants through children going into 5th grade
Any children going into 6th grade or older are welcome to join, but will be considered "helpers"
Nursery is provided for infants through 3 year olds
Games, crafts and movies will be geared toward 4 year old through 5th graders
Pizza, juice and water will be provided for dinner

*** REGISTRATION CLOSES ON WEDNESDAY, AUGUST 21ST AT 9PM ***

Child Name 1 (Last, First) *
Your answer
Gender *
Child Age *
Your answer
Child Birth date *
MM
/
DD
/
YYYY
Child Allergies *
Your answer
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