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)

Note: Parents who cancel before 12PM on Friday will receive a full refund. Any cancelation after 12PM will receive a 50% refund.

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