Date Night Registration 2026

Parent Info

Parent/Guardian 1

Phone

This address will receive a confirmation email

Parent/Guardian 2

Phone

Child Info

Child 1

Age

Grade

N/A Preschool Kindergarten 1st 2nd 3rd 4th 5th

Allergies

Medical concerns/special considerations

Child 2

Age

Grade N/A Preschool Kindergarten 1st 2nd 3rd 4th 5th

Allergies

Medical concerns/special considerations

Child 3

Age

Grade N/A Preschool Kindergarten 1st 2nd 3rd 4th 5th

Allergies

Medical concerns/special considerations

Child 4

Age

Grade N/A Preschool Kindergarten 1st 2nd 3rd 4th 5th

Allergies

Medical concerns/special considerations

Emergency Contacts - Please list someone other than yourself

Name

Relationship to family

Phone number

Name

Relationship to family

Phone number

Infant Feeding and Care Needs

If your infant will be joining us, we want to ensure they are comfortable and cared for. Please provide details about their feeding preferences and any special instructions. This information helps our team meet your child's needs and give them the best care possible.

Infant Feeding Preferences: Formula Breast Milk Solid Foods

Comfort Items: Does your infant need a pacifier, blanket, or special item for comfort? (If yes, please elaborate below) Yes No

Please specify feeding, care, and/or comfort item instructions for your infant:

More Info

Is there anything else you would like us to know about your family to ensure the Date Night evening goes smoothly?

Emergency Services Waiver

In case of emergency, accident, allergic reaction, or serious illness in the absence of a parent/guardian, I hereby authorize, by checking the “Emergency Services Allowed” box Adventure of Faith and its agents to perform any acts which may be necessary or proper to provide emergency health care for my child. This is including but not limited to consent to and authorization of medical procedures by emergency medical technicians, physicians, dentists, hospital or other emergency medical personnel, as they exercise what at their sole discretion, they deem necessary. Furthermore, by checking the “Emergency Services Allowed” box the parent/guardian understands that they are responsible for all costs and expense of such medical treatment.

Emergency Services Allowed

Date Night Registration 2026

Description

Please Fix the Following