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Parents' Night Out Sign-up Form

PYC Youth and their parents are sponsoring Parents' Night Out at Canyon Creek Presbyterian Church, 3901 North Star Road, Richardson. PNO is for children six weeks to 5th grade. Enter through the North Star Learning Center entrance - Registration begins at 6:30PM and pick up is no later than 10:30PM. Suggested donation: $25 for the first child and $5 additional for siblings. Donations support the PYC Youth Mission Trip. If you would like more information about Parents Night Out. Contact Kevin Starnes at: 972-238-8103 x311 or kstarnes@canyoncreekpres.org

Please download, fillout and return this Medical Release Form.
PARENTS' INFORMATION
Parent(s) Name(s) (*)
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Email Address (*)
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Preferred Phone # (*)
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CHILDREN'S INFORMATION
1st Child's Name (*)
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1st Child's Age (*)
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1st Child's School Grade (*)
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2nd Child's Name
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2nd Child's Age
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2nd Child's School Grade
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3rd Child's Name
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3rd Child's Age
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3rd Child's School Grade
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4th Child's Name
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4th Child's Age
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4th Child's School Grade
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