Kid's Night Out Pre-Registration

Child's Information

First Child's Name:

Age:

(if pre-school)

Grade:

(if elementary)

Second Child's Name:

Age:

Grade:

Third Child's Name:

Age:

Grade:

Fourth Child's Name:

Age:

Grade:

Parental Information

Parent / Guardian:

Address:

City:

Zip Code:

Emergency Phone:

E-Mail Address:

Notify by E-Mail:

Yes

Would you like to be notified by e-mail of upcoming children's activities?

Other Information

Medical Information:

Medical or other information we need to know about your child. Please include any food allergies or special instructions.

How did you hear about Kid's Night Out?:

Friend

FBC Church Member

Upward Visitation

Website

Will this be your first time in attendance?:

Yes