Kids Night Out Registration
Fill out the information below to sign your child(ren) up for Kids Night Out. Please note that this program is a library fundraiser for our Summer Reading Program. The cost is $25 per child (payable by cash or check). Registration will be limited to 20 participants between the ages of 5 and 12.
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Parent/Guardian name: *
Address: *
Phone: *
Email: *
Emergency Contact: *
Emergency Contact Phone: *
Child(ren)'s name(s) and age(s): *
Special concerns/conditions:
Who will pick your child up (must bring ID): *
By typing my name below, I hereby give approval for my child(ren) to participate in this program at the Somersworth Public Library. I waive, release, absolve, indemnify, and agree to hold harmless the Somersworth Public Library, employees, directors, and participants. *
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