Howdy! Looking to register your kids for Parent's Night Out? Look no further! Just fill out this form below and send it in. Payment will be taken when you drop your kids off at Parent's Night Out. Any questions, just let us know!

Parent's Name *
Parent's Name
Parent's Phone *
Parent's Phone
Child #1 Name *
Child #1 Name
Child #2 Name
Child #2 Name
Leave blank if not needed
if applicable
Child #3 Name
Child #3 Name
Leave blank if not needed
Leave blank if not needed
Child #4 Name
Child #4 Name
Leave blank if not needed
Leave blank if not needed
Please tell us any allergies and/or food restrictions pertaining to any child you are brining to Parent's Night Out. If none, please type "None"
Permission & Medical Release *
I, the parent or guardian, grant my permission for him/ her to participate fully in all Parent's Night Out program activities, events, and trips sponsored by Asbury Church. In the event treatment is called for in which a physician (or hospital personnel) is needed, I authorize adult leaders, volunteer or paid, to give such consent for all necessary medical treatment if we cannot be reached or if because of an emergency. Should medical help be needed, I agree to pay either directly and/or through my own health insurance policy all medical or hospital costs and to be solely responsible for said treatment and the cost thereof. I will keep my contact information up to date in charms so I may be contacted as needed.
Waiver of Liability *
I, the parent or guardian, in consideration of my child being allowed to participate in all Parent's Night Out activities, events, and trips, being the undersigned, intending to be legally bound, hereby waive and release all rights and claims for damages, for injury, accident, or liability of any kind which I might have against Asbury Church, church staff, volunteer leaders and other participants. I acknowledge that my child will participate at his/ her own risk.
Photo Disclaimer *
I, the parent or guardian, understand my child will be involved in Parent's Night Out program activities, events and trips and give permission for my child’s photo or video to be placed on the website, in newspapers, publications, or in other promotional materials.