Parents Night Out Registration | stpaulsfreeburg

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ST. PAUL'S UCC

FREEBURG, IL

A Faithful and Welcoming Congregation
Bringing Jesus' Love to All People to Make Heaven More Crowded

PARENTS' NIGHT OUT

First Child's First Name

First Child's Last Name

Child's Age

Any Allergies or Special Needs

Yes

No

If yes, please explain:

Second Child's First Name

Second Child's Age

Any Allergies or Special Needs?

Yes

No

If yes, please explain:

CONTACT INFORMATION:

Parent(s) Name(s)

Contact Phone

Alternate Contact Phone

Email

Can Anyone Else Pick Up Your Child(ren)?

Yes

No

If yes, who?

Relationship

Phone

In the event we are unable to reach you, who should we contact?

EMERGENCY CONTACT:

Name

Phone

© 2023 by St. Paul's UCC, Freeburg, IL

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