hosted by First Presbyterian Church of Edmond Kids' Ministry
1001 S. Rankin Street  | Edmond, OK  73034
 
405.341.3602  |  www.fpcedmond.org/kno
 
 
 
Welcome to the December Kids' Night Out registration form. This event is hosted by First Presbyterian Church of Edmond from 6:30-9:30 pm on Friday, April 5th at 1001 S. Rankin Street in Edmond as a community-wide ministry for children ages birth through sixth grade. This event has a variety of special activities for all ages.
 
KNO features pizza dinner, movies, crafts, and some surprises! We look forward to sharing an evening of fun and fellowship with your children.
 
Registration is open to the first 50 kids registered so sign-up early!
 
Please contact Danielle Jones, Associate Director of Kids' Ministry,
at 341.3602 if you have any questions.

Participant #1 Information

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Participant #2 Information

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Participant #3 Information

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Participant #4 Information

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Food Allergy Alert

Parent/Guardian Contact

Relationship to Participant: *
 

Authorization To Treat

If First Presbyterian Church of Edmond staff is unable to reach the parent/guardian AND the emergency contact person noted on this form, I do hereby consent to any medical care and the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child are under the care of First Presbyterian Church of Edmond in case of emergency. I understand and consent to allow my child to be transported to the nearest hospital or urgent care facility for the appropriate treatment by church staff and/or volunteers.
Please select a consent option below. *
Relationship to Participant: *
 

Photo & Video Release

By selecting I AGREE below, you grant First Presbyterian Church of Edmond and/or its representatives ownership and use of photographs, video, voice, recording, statements, and likenesses of my children for the purposes of promotion, public relations, marketing, social media, media, training, community relations, and/or advertising without restriction as to frequency, manner, and duration of use, without compensation to me.
 
For media stories, I understand that First Presbyterian representatives bear no responsibility for the contents of any news media coverage in which your children are included as a result of these interviews, photographs, audio, or video.
 
Since participants in this event are minors, by selecting I AGREE I certify that I am of full age and have every right to contract for the individuals whom I'm registering for the purpose(s) described.
 
If you wish to exclude registered participants from all photography, video, and audio captured at this event, please select I DECLINE below.
 *

Event Registration

How did you hear about Kids Night Out? (check all that apply)
 
Please choose how many children you would like to register for Kids Night Out. For families with more than two children, please select the Family option.
 *
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