Parents Night Out Registration

This fun night is designed to serve the parents in our church and community in Jesus’ love. We will feed the children a pizza dinner and show children’s animated movies. We will also have freshly made popcorn and crafts and games for children to play with. Children ages infant to 3 will be in the PreK room and children ages 4 and up will be in the Kindred Oaks pavilion.

Your name *

Email address *

Phone number *

Secondary Parent Name

Secondary Phone number

Secondary Email Address

Address *

Household

Please list all members of your family using the +add button below

Household members

Please note that pizza and popcorn will be provided. Please indicate below if your child has any food/ dietary restrictions.

Children's Ministry Authorizations

Individuals authorized to pick up your child *

(please include phone number and relationship to your child)

Emergency Contact *

(please include phone number and relationship to your child)

Photo Release *

Cornerstone Community Church occasionally has the opportunity to use photos to promote the Sunday School program, children’s choirs and other church activities. Uses might include the church website and social media.

I give Cornerstone Community Church permission to include my child(ren) in photos used for informational or promotional purposes.

I DO NOT give Cornerstone Community Church permission to include my child(ren) in photos used for informational or promotional purposes.

Parent Signature *

By signing this document, you are confirming that all the information is accurate and consent is given for care and any other stated permissions.

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