PNO '22-'23 Registration Form

Parent's Night Out

Hey parents! We know life gets a little crazy so we want to give you a few hours kid-free! We are having a Parent's Night Out on Friday, February 10th from 6:00 PM - 8:30 PM for kids infant through 5th grade. This event is designed for you, parents, to drop your kids off at the Locust Street Campus with our awesome GRACE Kids team and you can go on a date, relax for a little bit, binge a bit of that TV show you've wanted to start but haven't had time, and/or just have a few hours for yourself, or whatever it is, let us provide you with a kid-free night! Childcare is provided for kids pre-school age and under (infant - 4 years old) *PLEASE LIST ALLERGIES/MEDICAL CONCERNS FOR EVERY CHILD*
Parent Name*

First Name Last Name
Parent E-mail*
example@example.com
Phone Number

Area Code Phone Number
How many students will you be registering?
1st Student Name*

First Name Last Name
1st Student Grade*

Pre-K (click here for any child under 4 years old)K1st2nd3rd4th5th
1st Student Age*
Please list any allergies/medical information for your child.*
2nd Student Name*

First Name Last Name
2nd Student Grade*

Pre-K (click here for any child under 4 years old)K1st2nd3rd4th5th
2nd Student Age*
Please list any allergies/medical information for your child.*
3rd Student Name*

First Name Last Name
3rd Student Grade*

Pre-K (click here for any child under 4 years old)K1st2nd3rd4th5th
3rd Student Age*
Please list any allergies/medical information for your child.*
I give my child(ren) permission to participate in all GRACE Kids Parent's Night Out activities and to receive first aid treatment, if necessary.

I understand my child’s image may appear in print or online promoting church activities, including the church’s website, promotional brochures, worship presentations, social media, and the church’s YouTube channel. I understand that my child’s name will not be used in any of these circumstances. This permission form will be kept on file in the church office. If I would like to withdraw my permission, I may do so at any time.
Please respond to the above covenant.*

YesNoYes to participating in activities, no to my child's image being taken.
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Parent's Night Out