Parent's Night Out
Saturday, December 15 | 6:30-8:30 PM

Ages 6 weeks - Teens
Cost is just $5 (cash at door) per family and includes a light dinner.


STEP 1: Please complete one registration form per family.

  • If you have an infant, please provide enough milk/formula for the entire time you’ll be away.
  • If your child is new to PNO, and is upset when you drop him/her off, we will ask you to remain in the building for 10‒15 minutes to make sure they can be calmed.
PARENT/GUARDIAN INFO
**used for communication and confirmation emails - check for typos**


1st CHILD/TEEN INFO

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).



2nd CHILD/TEEN INFO

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).



3rd CHILD/TEEN INFO

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).



4th CHILD/TEEN INFO

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).



5th CHILD/TEEN INFO

PHOTO/VIDEO RELEASE
For privacy and safety, we will not publish names with photographs/videos.
I authorize the use/release of photographs and/or videos that include the INDIVIDUALS NAMED ABOVE for UCUMC use, in print and electronic materials (worship videos, e-mail blasts, church website, Facebook, etc.).



*RELEASE

Submitting this on-line form will be the equivalent of signing a paper registration form.

  • I have read and understand the above information. The information I have given UCUMC/EPIC is complete, accurate and true to the best of my knowledge.
  • My electronic signature signifies my understanding that submitting this online form will be the equivalent of signing a paper registration form.

 



When this form is processed, you will receive a confirmation email. Thank you!