Parent's Day Out 2025 Registration Form

Sometimes parents just need a few hours to breathe, and kids need a place to play, explore, and feel safe. Our Parents Day Out on Saturday December 13, 2025 from 10am to 2pm gives children a fun mix of crafts, stories, and activities while parents enjoy a little space to rest or get things done. Registration makes sure we’re ready to welcome your child with care and intention.

Child's Information

Child’s Name

Child's Preferred Name

DOB

Child's Gender

Male Female

Parent / Guardian Information

Parent/ Guardian's Name

Phone

Address

This address will receive a confirmation email

Emergency Contact (Other than Above Parent Guardian)

Name

Phone

Emergency Release

Please read and sign:

If my child becomes ill or injured during the Parent’s Day Out event, representatives of St. Matthew’s United Methodist Church will make every effort to contact me immediately. I authorize St. Matthew’s United Methodist Church to seek any necessary medical care in the event of an emergency. I accept responsibility for all medical costs.

Acknowledgment of Release

I have read and understand the Emergency Release.

Signature

Date

Child's Doctor

Doctor's Phone

Hospital Preference

Any Know Allergies?

Yes No

If yes, please explain

When my child cries, something that helps comfort them is:

Favorite toy or activity:

Anything else helpful for us to know:

Parent Agreement

I understand this is a one-day Parent’s Day Out event hosted by St. Matthew’s United Methodist Church from 10am - 2pm Saturday, December 13, 2025. I agree to follow check-in, pick-up, and safety procedures as outlined by the program staff.

Signature

Date

Photo Release

I understand that St. Matthew’s United Methodist Church may take photos or short video clips during Parent’s Day Out to capture moments of learning, play, and community. These images may be used in church communications such as slideshows, social media posts, printed materials, or future event promotions. No child’s name will be publicly shared.

Please select one:

I give permission for my child to be photographed or filmed during the event. These images may be used by St. Matthew’s United Methodist Church for ministry purposes. I do not give permission for my child to be photographed or filmed. I understand staff will make every reasonable effort to honor this request.

Signature

Date

Payment $10.00

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Parent's Day Out 2025 Registration Form

Description

Please Fix the Following