Parent Name (First & Last)*

Home Address*

Phone*
Email*

Child #1*

Name (First & Last)*

Birthday*

Interests*

Allergies*

Child #2

Name (First & Last)

Birthday

Interests

Allergies

Child #3

Name (First & Last)

Birthday

Interests

Allergies

Child #4

Name (First & Last)

Birthday

Interests

Allergies

Emergency Contact*

Name (First & Last)*

Phone Number*

Who will be picking up your child/children from Parent Night Out?*

Name*

Drivers License # of individual picking up from Parent Night Out.*

____________________________________

Elevate Hope House has my permission to take pictures of my child at Parent Night Out to potentially be used for social media to promote event.*

NoYes

Please print the waiver form and bring with you to Parent Night Out on February 14th. All families must have a signed waiver form to participate.
Download Waiver Form

If you would like to pay in advance through paypal or GiveMN.org, please click here to make your donation!

If you have any questions, please email [email protected] or call/text Melinda McDermott directly at 612.615.8824