Kids' Night Out

Saturday, February 9, 2019
5:00 PM 8:00 PM 17:00 20:00

Google Calendar ICS

Parent/Guardian:

First Name

Last Name

Parent/Guardian Address

List your street address.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Phone

List phone number where you can be reached in case of emergency.

(###)

###

####

Parent/Guardian Email

Parent/Guardian Permission

Emergency Medical Authorization

In case of emergency, if I cannot be reached by phone, I hereby give consent to Saint Andrew's United Methodist church staff and/or chaperones to seek medical treatment for my child.

Photo Authorization

I authorize Saint Andrew's United Methodist Church permission to use my child's likeness (photo/video) for the church website and/or social media. Saint Andrew's UMC will not provide names or any other identifying information related to my child.

Child's Name (1)

First Name

Last Name

Current Grade (Child 1)

Allergies (Child 1)

List any allergies your child may have.

Child's Name (2)

First Name

Last Name

Current Grade (Child 2)

Allergies (Child 2)

List any allergies your child may have.

Child's Name (3)

First Name

Last Name

Current Grade (Child 3)

Allergies (Child 3)

List any allergies your child may have.

Child's Name (4)

First Name

Last Name

Current Grade (Child 4)

Allergies (Child 4)

List any allergies your child may have.

Kids: Join us for a Winter Wonderland Pajama Party, featuring pizza and snacks, games, crafts, a movie, and a “snowball” fight! (Psst! Mom and Dad, this is your opportunity to enjoy a night to yourselves!) Cost is $5 per child, with a $10 cap. Childcare provided for ages three (must be potty-trained) through 5th grade. Note: Each child you plan to bring must be registered by completing this form. REGISTRATION DEADLINE: FEB. 2.

Please note: Drop-Off and Pick-Up: The doors will be unlocked from 5:00 pm until 5:30 pm but will remain locked for the safety of the children until 7:30 pm. A late fee will be charged for children picked up after 8:00 pm. All children MUST be signed in and checked out by the parents/guardians listed on the registration form. Saint Andrew’s United Methodist Church reserves the right to check parent’s/guardian’s driver’s licenses for identification.