Parents Night Out
March 28th 5:30-8pm | Please fill out this form and click submit.
Parent Information
Name
*
Email
*
This address will receive a confirmation email
Emergency Contact Number
*
Child Information
Child 1 Name
*
Child 1 Age
*
Child 2 Name
Child 2 Age
Child 3 Name
Child 3 Age
We want to care for your child well and make sure they have a great time. Is there anything we should know to help make that happen? (Allergies, Medical conditions, etc).
Allergies/Medical/Other Information
Parent Consent
I hereby consent to the participation of my/our child(ren) for Parents Night Out. While every precaution is taken for the safety and good health of all participants, the activities listed on our website for the Parents Night Out come with the inherent risk of personal injury beyond the risks associated with many of the regular activities at Calvary Baptist Church. I/we understand and accept these risks and agree that by allowing my child to participate in those activities, he/she may be taking part in this event that presents the potential for personal injury. I/we, the parents or guardians named below, authorize one of the Calvary Baptist Church Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above in the event a parent or guardian cannot be reached immediately. I/we, named below, undertake and agree to indemnify and hold blameless, Calvary Baptist Church, its personnel, its trustees and Board from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Calvary Baptist Church, as well as of any medical treatment authorized by the supervising individuals representing Calvary Baptist Church. I have read, understood and agree with above.
*
Please select all that apply.
Yes
Submit
Description
March 28th 5:30-8pm
Please fill out this form and click submit.
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