Parents’ Night Out

Stand by for our next Parent’s Night Out

You may bring your children to Grace UMC at 5 P.M.

We provide dinner while we teach and entertain your child. You just enjoy your date night.

Ages: Infant through Grade Six

Please pick up your child at 9 P.M.

Registration Required

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Fields marked with an * are required

Adult First and Last Name *

Email Address *

Family or Adult Address

City

Zip / Post Code

Primary Contact Phone (cell or other) *

Cell Phone 2

Child 1 - Name

Child 1 - Age

Child 1 - Does your child have allergies/special needs/ or is there additional information you can provide that would give us insight into your child to aid teachers and helpers? (Please indicate YES or NO below! If yes, explain) *

Child 2 - Name

Child 2 - Age

Child 2 - Does your child have allergies/special needs/ or is there additional information you can provide that would give us insight into your child to aid teachers and helpers? (Please indicate YES or NO below! If yes, explain)

Child 3 - Name

Child 3 - Age

Child 3 - Does your child have allergies/special needs/ or is there additional information you can provide that would give us insight into your child to aid teachers and helpers? (Please indicate YES or NO below! If yes, explain)

Child 4 - Name

Child 4 - Age

Child 4 - Does your child have allergies/special needs/ or is there additional information you can provide that would give us insight into your child to aid teachers and helpers? (Please indicate YES or NO below! If yes, explain)

Additional Adult Name (emergency contact)

Additional Adult Phone (emergency contact)

Spam Question: What is thirteen minus 10? *