Parent's Night Out Registration

Parent/Guardian Information

Parent/Guardian #1 Name

Parent/Guardian #1 Email

This address will receive a confirmation email

Parent/Guardian #1 Phone

Parent/Guardian #2 Name

Parent/Guardian #2 Email

This address will receive a confirmation email

Parent/Guardian #2 Phone

Address

Child(ren)/Youth Information

School District

Child #1

Child #1 - First and Last Name

Child #1 Birthdate

Grade/Age Child #1 for Fall 2025

Child #1 Allergies, special needs, medical conditions, etc. Please list below:

Child #2

Child #2 First and Last Name

Child #2 Birthdate

Grade/Age Child #2 for Fall 2025

Child #2 Allergies, special needs, medical conditions, etc. Please list below:

Child #3

Child #3 First and Last Name

Child #3 Birthday

Grade/Age Child #3 for Fall 2025

Child #3 Allergies, Special Needs, Medical Conditions, etc. Please list below:

Acknowledgements, Permissions, & Medical Release

I give Family of Christ permission to take photography and/or video of my child(ren) while participating and use photos/videos for promoting Family of Christ programs.

Yes No

I grant permission to Family of Christ Lutheran Church personnel to seek emergency medical treatment for my child(ren) should it be needed. I understand they will make every reasonable effort to contact me or the emergency contact I provide on this form.

Yes No

I, the undersigned parent or legal guardian of the child(ren) named above, hereby acknowledge and agree to the following: Assumption of Risk I understand that participation in activities at Family of Christ Lutheran Church involves certain inherent risks, including but not limited to minor injuries, illness, or accidents. I voluntarily assume all such risks on behalf of my child. Release of Liability In consideration for my child’s participation, I release and hold harmless Family of Christ Lutheran Church its owners, employees, volunteers, and agents from any and all claims, demands, or causes of action arising out of or related to any injury, loss, or damage that may occur while my child is in the care of the facility, except in cases of gross negligence or willful misconduct.

Yes No

I agree to all of the above and therefore sign this form.

Yes No

Any comments, suggestions, or other information we should know.

Suggested Donation

As this is a fundraiser for the Mission Trip, there is a suggested donation of $25 per youth registered. Please see your confirmation email for how to make the donation. Please be patient, as it may take some time for the confirmation email to be sent to you.

Parent's Night Out Registration

Description

Please Fix the Following