Register Parents Night Out | Legacy Church FL

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Parent/Guardian(s) First and Last Name

Please give the NAME AND AGE of each child separated by comma. Please indicate if you are dropping off any children who may not be potty-trained yet.

I understand that registration is not completed until each child's name and age is added to this form.

Parent Email Address

Parent Cell Phone Number

Parent Location (i.e. Shopping, Restaurant, Home etc.)

Emergency Contact Name and Phone Number (Different than Parent/Guardian)

Choose your Date Night :

Thank you for Registering!

COST: $20 for first child, $10 each additional child ($40 MAX)

You will be able to pay with cash when you drop off your child.

Notarized release forms for each child are required to be kept on file for attendance to this event.

If you haven't submitted these forms for 2021 yet, please click below to download the forms.