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Parent's Night Out Family Registration & Information Sheet
Ist Time Registration for PNO requires ALL parents to provide the information below. You only need fill it out one time. You do need to REGISTER you child or children each PNO by simply giving us there name. TIME 5:00PM - 8:30PM
Please enter your email, so we can follow up with you.
Please check how many children you will bring
First or Only Child's Name / Date of Birth / Age & Grade / ANY ALLERGIES
2nd Child's Name / Date of Birth / Age & Grade / ANY ALLERGIES (copy)
3rd Childs Name / Date of Birth / Age & Grade / ANY ALLERGIES (copy) (copy)
Name / Address / Phone Number of Emergency Contacts in case a parent cannot be reached
Name / Address /Phone of anyone other than the parent or emergency cont list above who is ALLOWED TO PICK UP YOUR CHILDERN:
Name of Physician / Phone Number of Physician / Address of Physician /
Emergency Medical Facility / Phone Number of Facility / Address of Faucitly /
PLEASE CHECK BELOW IF give consent for the facility to secure any and necessary medial care for my child.
Agree that we will sign our child in and out at every arrival and departure.
Agree that Northwest Hills United Methodist Church is not responsible for the personal property of our child.
Argee to abide by the Healthy Child Policy.
Agree to pick up our child by 8:30pm.
We agree for our child's photographs to be used in publicity documents such as website, brochure, and other advertisement (without using names).
Please let us know if you have any questions.