Parent's Night Out Sign up
Sign in to Google to save your progress. Learn more
Child's Last Name *
Child's First Name *
Child's Age *
Child's Grade *
Child's School *
Parent's First and Last Name *
Phone Number in case of emergency *
Please list any allergies if your child has any *
Is there any information about your child we would need to know in order to provide him/her a fun and safe environment from 4pm-8pm *
We the parents/guardians of the above-mentioned child, in consideration for his/her participation in Parent's Night Out hosted by the JCCHS Key Club, do hereby execute this agreement under which we voluntarily release and hold harmless all students, teachers, administrators, and Jackson County Board of Education from any and all liability whatsoever due to the injury, illness, accident, or other condition which may occur, directly or indirectly, during participation in Parent's Night Out. Please type your full name and today's date below. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jackson County School System. Report Abuse