PARENTS’ NIGHT OUT
Friday, September 10, 2010
5:00 – 10:00 p.m.
Cost: $15/child;$10/second child;$5 each additional sibling
Infants through 5th Grade
Bring a sack supper; milk will be provided!

Bring your children for an evening of fun, while you enjoy dinner and a movie (or go home to a quiet house)! Pre-registration required; to register complete the form below and return it to the child care office by September 8. Age-appropriate games and activities planned. Program will be staffed by LHLP staff and church volunteers. Call 862-1191 if you have any questions.
Invite other families you know to join the fun!!

REGISTRATION FOR
PARENTS’ NIGHT OUT
Friday, September 10, 2010
Southminster Presbyterian Church
9950 Southeastern Ave.
Indianapolis, IN 46239

Children’s Names:
_________________________________Sex_____Age______Grade_______
_________________________________Sex_____Age______Grade_______
_________________________________Sex_____Age______Grade_______
Parents or Guardians:______________________________________________________
Address:_______________________________________________________
Home Phone:_____________________Cell Phones:______________________ Emergency Contact:____________________________________________________

Any known allergies or health concerns:______________________________________________________
Signature of Parent or Guardian_______________________________________Date____________

Please return this form along with fee to Southminster Presbyterian Church – Loving Hearts Learning Place by September 8, 2010.