Parents Night Out Registration
Parents/Guardians Name
*
Childs name
*
Address
*
City, State, Zip
Contact Phone Number
*
Name of emergency contact
*
Emergency Phone Number
*
Age
*
Are you allergic to milk?
Yes
No
Are you allergic to nuts?
Yes
No
Other allergies if any
Are you currently a member of or regularly attending a church?
*
Yes
No
Do you want a call from the pastor for more information about Westlane Christian Church?
*
Yes
No
By filling out this online form and answering “Yes” to the following question you are aware and accept the risks of physical injury associated with participation in Westlane Christian Church’s (WCC) Parents Night Out. Also the participant (or parent/guardian) accepts financial responsibility for any bodily or personal injury sustained during Parents Night Out. Further, the participant (or parent/guardian) promises to hold harmless WCC and its representatives for any injury related to Parents Night Out. You also agree if a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable arbitration process.
*
Yes
No
Form filled out by:
*
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