Parents Night Out Registration Form

Child Information
Parent Information
Emergency contact Information if Parent cannot be reached
Parental Consent for Medical Treatment
With the increasing sophistication of our medical systems, we are finding it necessary to have parental release forms in the unlikely event of some serious injury requiring medical treatment. This release give us permission to take your child to the nearest available medical facility and have the necessary treatment administered. This is not necessary from our perspective, but from your perspective, as many hospitals will not administer any medical attention to a minor without some parental consent. IN CASE OF EMERGENCY, I UNDERSTAND EVERY EFFORT WILL BE MADE TO CONTACT ME. IF I CANNOT BE REACHED, I GIVE HOMESTEAD UMC PERMISSION TO ACT ON MY BEHALF IN SEEKING EMERGENCY TREATMENT FOR MY CHILD, IN THE EVENT THAT SUCH TREATMENT IS DEEMED NECESSARY BY HOMESTEAD UMC. I GIVE PERMISSION TO THOSE ADMINISTERING EMERGENCY TREATMENT TO DO SO, USING THOSE MEASURES DEEMED NECESSARY. I ABSOLVE HOMESTEAD UMC YOUTH MINISTRIES STAFF AND CHURCH FROM LIABILITY IN ACTING ON MY BEHALF IN THIS REGARD SO LONG AS HOMESTEAD UMC IS NOT GROSSLY NEGLIGENT.
I understand any medical charges will be billed to me personally or directly to my insurance company.
Photo Release
I give permission to Homestead UMC to use photos of my child to record, promote, and celebrate this congregational event. Photos may be used in a variety of ways, including, but not limited to: Homestead’s website, social media page (facebook), slide show, or newsletter. An opt out form is available, upon request, if preferred.;
Upcoming Events
Yes! Keep me updated of other similar/upcoming events for my family/child(ren) at Homestead Church!

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