Registration

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PARENTS NIGHT OUT ... 5:30-8:30PM
Let us watch the kids, play games, make crafts, and keep them safe at our place.
We have lots of activities to keep the kids moving so we'll be sure they're ready for bed when you get them back.
The evening starts at 5:30 p.m. and ends at 8:30 p.m.
LifeStage Parents Night Out Pricing: (All proceeds will benefit the LifeStage Youth Advisory Board)
First child $25
2 children $40
3+ children/family $60
Multiple child discounts apply to immediate family members only!
You must submit a separate enrollment for each child.

Online registration ONLY and closes at 8:30 p.m. the Friday before the event.
Phone registrations will NOT be accepted.
You may also register at the door with cash or check, if event is not full.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Relationship*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info

Students entered below will be added to your family's account

Questions/Options:


List any medical conditions including any allergies, physical limitations or any other concerns that might affect your child's participation in this event. *

Additional Information:

Liability Waiver - Insurance Disclaimer - Photographic and V

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I understand that this Parents Night Out event is provided by LifeStage Theatre and volunteers aged 12 - 16, and understand the inherent dangers involved with my child’s participation, including the risk of personal injury and/or damage to my child and/or my property while participating in this event. I further understand and acknowledge that participants in this event are not covered under insurance of LifeStage Theatre, Lifesong or any of the individuals volunteering at this event and these groups will not allow participation in this event absent my signing this release. I authorize and grant permission for a representative of LifeStage Theatre to treat minor injuries such as scrapes, small cuts, splinters, and insect bites. I authorize and grant permission for a representative of LifeStage Theatre to obtain emergency medical care from any licensed physician or hospital and/or medical clinic should my child become ill or injured while participating in this event if the parent or guardian designated above is not available to grant authorization for emergency treatment. I therefore freely and voluntarily execute this release with such knowledge, assume the risk of personal injury and/or property loss arising from or in any way connected with participation in this event. I, for myself and anyone entitled to act on my behalf, hereby release and discharge LifeStage Theatre, and any and all agents of LifeStage Theatre including any volunteers working on its behalf, from any liability, claim, cause of action, demand or damages from injury or damages of any kind to my child or my property as a result of participation in this Parents Night Out. I grant permission and understand that photos and other images taken during this event could be used in print advertisement and other forms of media including social media such as Facebook and Instagram. I further waive, release, absolve and agree to indemnify and hold LifeStage Theatre, Lifesong and any volunteers working on their behalf harmless as a result of participation in this Parents Night Out. I have read the Parents Night Out rules and understand that my child and I must adhere to them. I understand that should my child become disruptive during the event that LifeStage Theatre may choose to release him/her from the event with no refund. I understand that LifeStage is not responsible for any lost items.