Parents' Night Out

Name

This address will receive a confirmation email

Phone

Childcare Registration

Childcare will be provided by our student ministry leaders and students to raise money for summer camp. Suggested donations are $25/first child + $20/each additional child. Please donate when you drop your children off the night of the event. You will be able to donate using our online payment system, cash, or check.

Please list the names and ages of your kids:

Please list any allergies or special instructions we need to know related to the care of your children:

Donation

Below are the suggested donations: $25/first child + $20/each additional child. If you would like to donate an alternate amount, please click HERE and choose "Student Ministries Camp" from the drop-down menu.

Suggested Donations:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Friday, February 17 -- 6-10pm

Please fill out this form and click submit.

Parents' Night Out

Description

Please Fix the Following