Parents' Night Out Child Registration Form

Family & Friends Day Childcare Registration Form

Please fill in the form below to register. $20/per family. Parents/Guardians will pay the childcare staff CASH ONLY during event check-in. PARENTS/GUARDIANS MUST REMAIN ON-SITE AT ALL TIMES. A pizza dinner will be provided. Feel free to bring a blanket/pillow if your child is an early-sleeper.
Childcare Seat (3 years to 10 years old ONLY)*
Name of Child*

First NameLast NameAge
Name of Child

First NameLast NameAge
Name of Child

First NameLast Name Age
Name of Parent/Guardian*

First NameLast Name
Parent/Guardian Phone Number DURING the event*
Name of Additional Emergency Contact*

First NameLast NameRelation to Child
Phone Number of Additional Emergency Contact*
Allergies, Medications, Other Medical Alerts or Behavioral Concerns*
Pizza (click "Other" if Your Child is Allergic)

CheesePepperoniEither
RELEASE AND WAIVER

In consideration of my child participating in childcare, I hereby release Mother Mary Lange Catholic School, Archbishop William Lori, Roman Catholic Archbishop of Baltimore, a corporation sole, and their agents, employees, and principals, of and from any and all liability, claims, demands, actions, and causes of actions whatsoever, arising out of or related to any loss, damage, or injury that may be sustained by my child or children. I hereby grant permission for my child to participate in childcare. I acknowledge receipt of the information describing the details of the experience.
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Family & Friends Day Childcare Registration Form