Evolve KidsCare: Parents Day Out Registration

Registration for Evolve KidsCare: Parents Day Out

Helping families in recovery grow stronger, one night at a time
All registrations are received and reviewed in a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

AGES: 3-12 YEARS OLD AND MUST BE POTTY-TRAINED.

SATURDAY DECEMBER 6, 12:30PM-4:30PM. ALL OTHER SATURDAYS ARE 2PM-6PM. STRICT 4 HOUR TIME FRAME - MUST BE PICKED UP BY CLOSING.

LOCATION: MT CARMEL UMC, 4760 MOUNTAIN ROAD, PASADENA, MD 21122
Which date do you want to register for?*
Will you be attending the full time? If no, please identify which time your child will be attending.*
How did you hear about Evolve KidsCare?*
Parent/Guardian Information
Full Name*

First NameLast Name
Phone Number*
CHILD INFORMATION

If more than one child, please fill out for each child attending
Child's Name 1*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Child's Name 2

First NameLast Name
Date of Birth

MonthDayYear
Date
Child's Name 3

First NameLast Name
Date of Birth

MonthDayYear
Date
Child's Name 4

First NameLast Name
Date of Birth

MonthDayYear
Date
Child's Name 5

First NameLast Name
Date of Birth

MonthDayYear
Date
Emergency Contact - Other than Parent/Guardian
Full Name*

First NameLast Name
Phone Number*
Address

Street Address

Street Address Line 2

CityState

Zip Code
Authorized Pick Up

Provide full name and phone number of anyone authorized to pick up your child. Must have identification. Anyone not listed will NOT be allowed to pick up your child.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Any additional comments:
Signature*

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Registration for Evolve KidsCare: Parents Day Out

Parent/Guardian Information

CHILD INFORMATION

Emergency Contact - Other than Parent/Guardian

Authorized Pick Up