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Get Parent S Night Out Registration Form - Odschools.org

Date If you should have any questions or concerns please contact us at the numbers below. Carol Messer 574-207-3614 Rhonda Noble 574-344-6625 jdmesser3 hotmail.com chgogirl03 aol.com Ne ed a R A P Br eak S T EN O NIGHT UT Games Activities Swimming Movie Music Face Painting Food es d Gr 6 Kt Da Friday November 20th ht g i eN At Oregon-Davis Elementary 5-9 pm cst 15 for First Child Pre-Registerd or 20 at Door 5 for Each Additional Sibling Ch r Sh istm op pin s 30 max Monday November 9th Sponsored by the Junior Parents After Prom Committee. Parent or Guardian must come into school to sign-in and sign-out child/children. Pre-registration deadline is Monday November 9 2015. I also agree that my insurance carrier or I will bear the financial responsibility for any medical treatment administered under the above guidelines. Return completed registration form and payment to the teacher or office. Make checks payable to OD Jr. I grant permission to a qualified physician and/or other medical personnel to furnish medical care using the above guidelines while my child/children attend the Junior Parents After Prom Committee s Parents Night Out. Parents. Name Relationship Address Home Phone Cell Phone Emergency Contact other than person listed above Children Attending Parents Night Out Child Name Age Grade Pizza or Hot Dog Any Allergies Restrictions or Special Instructions I hereby allow my child/children to participate in the Junior Parents After Prom Committee s Parents Night Out and assume all risks and in consideration of his/her participation in said program do hereby waive and release all claims arising as a result of personal injures or property loss during the program. I furthermore authorize the staff in the event of illness or injury to administer emergency care and to arrange for any medical transportation to the nearest heath care facility deemed appropriate. Parent s Night Out Registration Form Activities available subject to change Open gym swimming face painting movie various game stations video gaming music and more. Meal is included with their choice of pizza or hot dog with a drink and cookie. There will be additional food drinks and candy available for purchase. I understand every effort will be made to contact the parent or guardian prior to any involved treatment. Parent s Night Out Registration Form Activities available subject to change Open gym swimming face painting movie various game stations video gaming music and more. Meal is included with their choice of pizza or hot dog with a drink and cookie. There will be additional food drinks and candy available for purchase.

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