Ark & Dove Presbyterian Parents Night Out Youth Fundraiser

Ark & Dove Parents Night Out Youth Fundraiser

To benefit youth activities such as GenOn Summit and the Youth Mission Trips
The youth of Ark & Dove are sponsoring Parent's Night Out on February 18, 2017 from 5 to 9 pm. Please bring a snack to share and pillow and blanket if your child wishes to lay down. A quiet room will be provided. All ages welcome! Advance RSVP is preferred but not required

The evening will include dinner, activities, and movies!

Cost = $20 per child / $10 per additional child
Primary Contact

First Name Last Name
Mobile Number *

Area Code Phone Number
E-mail *
Name(s) and Age(s) of children needing care
If children are under they age of 4, are the potty trained?

Yes No
Anything the sitters need to know? (Allergies, food aversion, etc)
Liability Waiver

My child(ren) are of acceptable behavior and medically able to participate in Ark & Dove's Parent’s Night Out. My children will abide by all decisions of adult supervision at Parent’s Night Out. I assume all risks associated with Parent’s Night Out, including but not limited to falls, contact with other participants, the effects of the weather, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my form to participate in Parent’s Night Out, I, for myself and anyone entitled to act on my behalf, waive and release Ark & Dove Presbyterian Church and its officers and agents, all sponsors, their representatives and successors from all claims or liabilities even though liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

I understand that Ark & Dove is not responsible for lost items during the Parent's Night Out.
E-Signature *
If you have questions, please contact Amy Tardiff or Laura Talbert.
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Ark & Dove Parents Night Out Youth Fundraiser