Parents Night Out Child Registration

Parent/Guardian Name

This address will receive a confirmation email

Phone

Emergency Contact

Your emergency contact will be the next point of contact if we cannot reach the parent/guardian listed above.

Name

Relation to Child

Phone

Children Information

Please list the first and last name of children that will be dropped off and their ages.

Allergies - Please list the child's first and last name and any allergies they have.

Special Concerns - If applicable, please list the child's first and last name and any special needs they may require.

Description

November 29th, 2025 | 4:00p-8:00p (Doors open at 3:45p)

Thanks for being a part of our Parents Night Out Fundraiser! All proceeds will go toward Kids Camp.

📅 Date: Saturday, November 29, 2025
🕓 Time: 4:00–8:00 PM (Doors open at 3:45 PM)
👶 Ages: 6 months – 12 years

What to Expect:
Kids will enjoy pizza, crafts, games, and a Christmas movie! Each class will be staffed by CPR & First Aid certified volunteers.

Registration:
Please complete the form below to pre-register your child(ren).
🗓️ Register by: November 26

💲 Cost: $40 for the first child, $10 for each additional child
All payments will be made at drop off.
Example:
1 Kid: $40
2 Kids: $50
3 Kids: $60

📍 Location: Central Assembly of God
2020 Bedford St, Cumberland, MD 21502

Parents Night Out Child Registration

Description

Please Fix the Following