Parents’ Night Out – Nov 22 – Sign-Up

Give yourself a break while your kids have fun in the Gym (LifeCenter). We’ll have games, crafts, and pizza & drinks. Your registration supports our Youth Ministry and the Summer 2026 Service-Learning Trip.

Saturday, Nov 22, 4:30–7:30 PM
8051 E Broadway Blvd (LifeCenter building — Gym entrance)

Ages: 3-11 (potty trained)
Drop-off: Check in at the Gym entrance; sign-in required

Pick-up: Photo ID required; approved adults only
Cost: $25 (1 child) • $40 (2) • $50 (3+ same family)

Includes: Games, gym time, crafts, pizza & drinks
Allergies: Please note any food allergies below.

Questions: Luis • 815-202-2000
Limited spots.

Important note: Adult leaders on site at all times (youth helpers assist).

Parent/Guardian

Full Name

This address will receive a confirmation email

Phone

Number of children

1 2 3+

Children attending (please add names & ages)

Names & Ages

Allergies / medical notes / Special accommodations

Safety & pickup

Approved pickup adults (names & phones) - List all adults who may pick up. Photo ID required.

Emergency contact (name & phone)

I am giving permission for my child (ren) to participate in Parents’ Night Out: Adults on site to give basic first aid and, if needed, to seek emergency medical care. The church to be released from liability for ordinary accidents that can happen during normal, supervised activities.

Yes

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Parents’ Night Out – Nov 22 – Sign-Up

Description

Please Fix the Following