LakeRidge United Methodist Church
Parents' Night Out - May 4th
Complete the following information and click Submit. You will receive a confirmation page and an email upon completion of the form.
Registration fee is $12 per child, or $30 for families with 3 or more children. Payment is due at time of registration. A 3% credit card transaction fee will be added to the total when you check out.
Please eat prior to attending. Only a light snack will be provided.
Are you a LakeRidge UMC Member?
Choose One
Yes
No
Parent/Guardian Name
First
Last
Parent/Guardian Phone Number
*
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Parent/Guardian Email
Number of Children Attending
1
2
3 or more
Child's Name
*
First
Last
Date of Birth
*
MM
/
DD
/
YYYY
Group based on Grade
*
Select One
0-12 Months
12-24 Months
2 Year Olds
3 Year Olds
4 & 5 Year Olds
Kinder & Up
Child's Name
First
Last
Date of Birth
MM
/
DD
/
YYYY
Group based on Grade
*
Select One
0-12 Months
12-24 Months
2 Year Olds
3 Year Olds
4 & 5 Year Olds
Kinder & Up
Child's Name
First
Last
Date of Birth
MM
/
DD
/
YYYY
Group based on Grade
*
Select One
0-12 Months
12-24 Months
2 Year Olds
3 Year Olds
4 & 5 Year Olds
Kinder & Up
Child's Name
First
Last
Date of Birth
MM
/
DD
/
YYYY
Group based on Grade
*
Select One
0-12 Months
12-24 Months
2 Year Olds
3 Year Olds
4 & 5 Year Olds
Kinder & Up
Emergency Contact if you can't be reached:
Emergency Contact's Phone:
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Please list any dietary allergies or physical special needs:
Do Not Fill This Out