Parents Night Out ATTENDEE

🌟Parents' Night Out Presented by ASA Now🌟

Join ASA Now for our Parents' Night out event. Caring for children who have been victims of abuse or neglect and live with the effects of trauma can cause caregiver burnout. Our Parents’ Night Out events will give you a break to recharge and refresh.

🗓️ When: Saturday February 15th, 2025

⏰ Time: 1:00 PM to 4:00 PM

📍 Location: ASA Now - Jacob's Mission Community Center

🏠 Address: 7830 E. University Dr. Mesa, AZ 85207

✨ Who can attend: DCS Kinship Caregivers, Licensed Foster Caregivers, Foster/Adoptive Caregivers, and Guardianship Caregivers for children who previously were or are under the custody of Arizona Department of Child Safety (DCS). This service is offered to all the children who currently reside in in your home, ages newborn to 18,

💲 Cost: The cost for this event is $20 per family (foster, kinship, child welfare guardianship or foster/adopt) which includes dinner, 3 hours of childcare, snacks, games, activities, and prizes for ALL of the children and/or youth in your home (bio kids welcome). Payment received will go directly to help offset the operation and maintenance cost of Jacob's Mission Community Center.

🤝 We have a limited amount of sponsorships available per event for families facing financial hardship. If you would like to be considered for a sponsorship, please email us at Hope@asanow.org.

For questions, call (623) 428-1592 or email Volunteer@ASANow.org

✨ Event information: Many children coming through the foster care system have special physical, mental health and developmental needs. Many of these children have suffered varying degrees of trauma, neglect and abuse which often manifests as challenging and extreme behaviors requiring above-average attention.

Caring for children impacted by foster care on a daily basis can be very stressful and difficult for foster and adoptive parents. This ultimately takes a toll on the family as a whole. Our community center provides a much needed break for exhausted foster and adoptive parents while still meeting the special needs of the children. This intervention provides parents with an opportunity to recharge, prevent burn-out, stabilize the whole family, and ultimately result in fewer foster and adoptive disruptions.

Note: if you do not want your child to be photographed, please send them wearing a RED SHIRT. This will help us identify which children we cannot photograph.

There will be staggered drop-off times as well as check-in times.

Cancellation:

Due to the time and effort that it takes to put these events together, we want you to be aware that there are NO REFUNDS or CREDITS.

Failing to attend or not notifying us will exclude you from attending future Parent Night Out events. We understand that emergencies happen. If you are unable to attend, you MUST notify us ahead of scheduled drop-off time and we ask that you give us as much notice as possible by calling 623-428-1592. Be sure to leave a voicemail or text if we don't answer.

Childcare:

We will do our best to provide childcare to all families who request it, however, our ability to do so depends on the number of volunteers who sign up to help. If your family is selected for childcare, we will send a confirmation email with the check-in information no later than two (2) days prior to the event. Please note that there will be staggered check in times as well as check-out times.

Childcare Activities:

We will be playing games, doing crafts, and serving pizza and fruit. If you have children with restrictive diets and/or food allergies we ask that you bring them a sack lunch labeled with their name. If their allergy requires an epi-pen please be sure to bring it and give it to a supervisor at check-in.

For each child we request that you bring an index card with information that volunteers should be aware of for children with special needs and/or allergies written down. Hand the card to your child's volunteer AND verbally explain the information to the volunteer assigned to your child at the event. This will help ensure that your child stays safe.

If your child has a particular food that they like, toys or card games, please provide those to the volunteer.

Additionally, we ask that you bring a change of clothes for each young child. Bring all clothing in a backpack labeled with your family's last name. if your child tends to have accidents or is potty training, please let the volunteer know and please send them in pull ups. Be sure to bring diaper bags for the little ones with enough formula and comfort items and preferred snacks to keep them as happy as possible while you are attending the workshop. Be sure to label the diaper bag with your last name as well.

**PLEASE DO NOT BRING CHILDREN WITH LICE OR NITS, OR ANY SYMPTOMS CONSISTENT WITH COVID OR OTHER CONTAGIOUS ILLNESSES**

Before you drop off your child, make sure you’ve done the following:

1. Put a name tag with your child’s first and last name on the back of their shirt.
2. Write any dietary restrictions, food allergies, or any other behavioral or special needs your child may have on an index card. One index card per child.
3. Please bring a labeled diaper bag for any child in diapers, or a labeled backpack for your family with spare clothes and any other necessary items for children who are potty trained.

We need to capture some important information. Please take a moment to fill this form out in its entirety. Please list children from youngest to oldest. If a child or youth leaves your home or a new one is placed, please let us know as soon as possible.

NOTE: We need to plan accordingly. Only sign up those who will be in attendance and currently reside in your home. We thank you for your patience with the sign up. To streamline our gift distribution, it's crucial for us to gather important data. As a foster care charitable organization, we are obligated to report demographics and information about the families we serve.

Changes in Family: If you experience changes in your family, such as a foster child leaving your home after registration or a new placement entering your home, please contact us as soon as possible. This ensures that we can update your registration and make adequate preparations to ensure that we have enough gifts, food, and prizes for all attendees.

Feedback:

Our donors and volunteers love feedback. If ASA Now has blessed your life, please take a minute to leave a positive review on Google and/or on our ASA Now Facebook Page or email us at Hope@asanow.org with your testimonial.

For a list of our upcoming events, check out our Events tab on Facebook or visit our website at www.asanow.org

With Gratitude,

Angela Teachout

Susan Woodruff

Anika Robinson

'Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has". Margaret Mead
We need to capture some important information to help coordinate care.

Please take a moment to fill this form out in it's entirety.

If you are in need of childcare, we ask that you please list children from youngest to oldest.

If a foster child leaves your home or a new one is placed, please let us know as soon as possible.

*Be sure to CONSENT, SIGN & hit the SUBMIT button along with your payment. An automatic confirmation email will be received*
Select Parent Day Out Date to Attend*

Saturday, 2/15/25 from 1 PM to 4 PM
If you are a Foster or Kinship family, would you like to be considered to receive Free Food and Clothing?*

YesNo
Are you an (check all that apply)*

Unlicensed Kinship CaregiverLicensed Kinship CaregiverLicensed Foster CaregiverTribal Foster CaregiverCaregiver with Guardianship to Child with Child Welfare InvolvementFoster/Adoptive Family
Primary Caregiver's Name #1*

Last NameFirst Name
Primary Caregiver's Name #2

Last NameFirst Name
Current Address*

Street Address

CityPostal/Zip Code

COUNTY you reside in
Cell Phone Number*

Area CodePhone Number
Emergency Cell Phone Number (only required if childcare is needed)

Area CodePhone Number
E-mail*
Total Number of People Currently Living in the Home?*
Includes all Adults and Children
Number of Adults Living in the Home?*
(This includes adult children age 18 and over who are out of high school)
Total Number of Children Living in the Home?*
(Children under 18 and those over 18 who are still in high school)
Number of Foster, Tribal Foster, or DCS Guardianship Children Living in the Home?*
(This does NOT include non-DCS kinship or guardianship without DCS involvement.)
Number of Adopted Children Living in the Home?*
(Under 18 and those over 18 who are still in high school)
Number of Biological Children Living in the Home?*
(Under 18 and those over 18 who are still in high school)
Number of Non-DCS Kinship or Guardianship Children WITHOUT DCS Involvement Living in the Home?*
(Under 18 and those over 18 who are still in high school)
How many children will be in attendance ?*
How many of the total number of children in attendance are foster/tribal/DCS guardianship children?*
Based on family size, does your family fall below the following income levels: One (1) person: $20,385, Two (2) people: $27,465, Three (3) people: $34,545, Four (4) people: $41,625, Five (5) people: $48,705, Six (6) people: $55,785, Seven (7) people: $68,865, Eight (8) people: $69,945. Add $4,720 per additional household member.

YesNo
If you have a FOSTER, TRIBAL FOSTER, or DCS GUARDIANSHIP CHILD please click YES and enter their information first, otherwise click NO. If you do not need childcare for this event, please click NO.

YesNo

Click Here to register additional children OR complete registration
Continue with Sign-up

Yes, register more childrenNo, go to consent and submit form

Click Here to Consent
Liability Release - I do hereby release ASA Now, Jacobs Mission Community Center, their agents, employees, personal representatives, affiliates, and any and all persons, firms or corporations liable or who might be claimed to be liable, whether or not herein named, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, arising out of or in any way relating to injuries and damages, as a result of being present on Jacobs Mission Community Center. I recognize that there may be inherent risks associated with attending or participating in this event. You have been fully informed of your consent, waiver of liability, and release before entering the event.
I have reviewed, understand, and agree to comply with the above terms*

Agree
By attending or participating in this event, you consent to interview(s), photography, audio recording, video recording and its/their release, publication, exhibition, or reproduction to be used for news, web casts, promotional purposes, telecasts, advertising, inclusion on websites, social media, or any other purpose by ASA Now and Jacobs Mission Community Center. Images, photos, and/or videos may be used to promote similar ASA Now events in the future, highlight the event and exhibit the capabilities of ASA Now. You release ASA Now, its officers and employees , and all persons involved from any liability connected with the taking, recording, digitalizing, or publication and use of interviews, photographs, computer images, video and/or sound recordings. By entering the event premises, you waive all rights you may have to any claims for payment or royalties in connection with any use, exhibition, streaming, web casting, televising, or other publication of these materials, regardless of the purpose or sponsoring of such use, exhibiting, broadcasting, web casting, or other publication irrespective of whether a fee for admission or sponsorship is charged. You also waive any right to inspect or approve any photo, video, or audio recording taken by ASA Now, Jacobs Mission Community Center or the person or entity designated to do so by ASA Now. You have been fully informed of your consent, waiver of liability, and release before entering the event.
I have reviewed, understand, and agree to comply with the above terms*

Agree

Check Out *

PNO FEE$20.00

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Total $0.00

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