Parent's Night Out!

Saturday, April 19th / 5pm - 8pm

First name

Last name

Phone Number

Additional Emergency Contact

Emergency Contact Phone

Child #1 Name

Child #1 Age

Child #2 Name

Child #2 Age

Child #3 Name

Child #3 Age

Child #4 Name

Child #4 Age

Child #5 Name

Child #5 Age

Please list any and all allergies, sensitivities, special needs, or anything else we need to know about your child(ren)

Risk/Waiver Liability

As the parent or guardian of the above referenced child(ren), I give permission for my child(ren) to participate in Parent's Night Out at Commonplace. I recognize that this is a drop-off event that involves physical games and activities that carry inherent risks. I agree to waive all claims against Commonplace Homeschool Cooperative and its owners and volunteers for any liability, loss, cost, damage, medical expense, or emotional distress arising out of any personal injury.

Photo Release Wavier

I hereby grant consent and authorize the use of photographs and video recordings of my child(ren) participating in Commonplace activities for commercial and purposes of any medium of advertising, communication, publication, or publicity that will promote Commonplace programs

Parent's Night Out!

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