Parents Night Out - Abundant Life Baptist Church

Parents Night Out - Abundant Life Baptist Church - Troy, MO

Friday, December 12 - 5-9pm
How many children are you registering?
Child Information
First Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Last Grade Completed
Does the child attend church anywhere?
Where?
Medical or other information we may need to know about the child (including food allergies).
Second Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Last Grade Completed
Does the child attend church anywhere?
Where?
Medical or other information we may need to know about the child (including food allergies).
Third Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Last Grade Completed
Does the child attend church anywhere?
Where?
Medical or other information we may need to know about the child (including food allergies).
Fourth Child
Child's Name

First NameLast Name
Child's Birth Date

MonthDayYear
Last Grade Completed
Does the child attend church anywhere?
Where?
Medical or other information we may need to know about the child (including food allergies).
Child Release Information
Parent/Legal Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names of Persons to which the child (children) may be released during or after the activity (Please provide at least two)

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
Are there any persons to which the child (children) may NOT be released?
Name(s) of individual(s) the child (children) are not to be released to:
Emergency Contact 1 (other than parent/guardian listed above)

First NameLast Name
Emergency Contact 1 Phone Number

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)

First NameLast Name
Emergency Contact 2 Phone Number

Area CodePhone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.
Should be Empty:

Parents Night Out - Abundant Life Baptist Church - Troy, MO

Child Information

First Child

Second Child

Third Child

Fourth Child

Child Release Information

Media Release