Edge&#039;s Parent&#039;s Night Out!

Parent's Night Out Registration Form:

Child's Information:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth: REQUIRED Please fill out this field. Please enter valid data.

Age Group 3 year olds 4 year olds 5-6 7-8 9-10 11 & up

Gender: REQUIRED Please fill out this field.

Medical Allergies / Special needs: Please enter valid data.

Is your family registered at Prince of Peace? REQUIRED Please fill out this field.

If not, which parish? Please enter valid data.

Parent/Guardian (1) Information:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Receive Texts? Yes No

Email REQUIRED Please fill out this field. Please enter an email address.

Parent/Guardian (2) Information:

First Name Please enter valid data.

Last Name Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Receive Texts? Yes No

Emergency Contact Information:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to child: REQUIRED Please fill out this field. Please enter valid data.

Thank you for signing up! Please fill out and bring a copy of the Parish Permission slip (below) and bring it with you when you drop off your child!

Signature: REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Edge's Parent's Night Out!