Parents' Night Out form:

Parents' Night Out Participation Form

Division of the Children's Ministry

January 28, 6-10pm

Deadline to register is Wednesday, January 25

Questions, contact Debbie Barron: 546-5826, ext. 123

Fees: (includes meal)

$15 first child/$5 each additional child (Children MUST be siblings to qualify for discount.)

$25 Maximum per family

Fee must accompany form and is non-refundable.




Child(ren)'s name and age (18 months through 5th grade)


Mother's name and cell phone number


Father's name and cell phone number


Emergency contact



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