Central Heights Church | Abbotsford, BC

Parents, do you want to go on a date with your spouse or are you a single parent who wants an evening to yourself? Let us take the kids for the evening!

Date: Friday, May 10
Cost: $10 per child (up to $30 per family) \\ Pizza dinner included
Time: 5:30pm - 8:00pm
Where: Drop off and pick up at the Kids Area at Central Heights

Register online using the form below. Registration deadline is Wednesday, May 8

*Denotes Required Field * Title

* Parent(s) Name(s):

* Email:

* Phone: ( ) -

Emergency Contact

If parents cannot be reached.

* Emergency Contact Name:

* Relationship to child(ren):

* Emergency Contact Number: ( ) -

If you need to pick up your child(ren) at a time earlier than 8:00pm, please let us know what time:

CHILD #1

* Child Name:

* Birthdate:

* Gender:

Female
Male

* Age:

Any medical info we should know:

Child #2

Child Name:

Birthdate:

Gender:

Female
Male

Age:

Any medical info we should know:

Child #3

Child Name:

Gender:

Female
Male

Birthdate:

Age:

Any medical info we should know:

Child #4

Child Name:

Gender:

Female
Male

Birthdate:

Age:

Any medical info we should know:

PAYMENT/REGISTRATION INFO (PLEASE READ):

To complete your registration, you will be taken to our payment page.

Each child will cost $10 for the whole evening (maximum of $30 per family - includes dinner)

You will need to enter the appropriate amount on the next screen. On the payment screen you will also need to fill out your billing information. You may want to take the time to set up an account on the next screen to save you time in the future.

parents night out

Emergency Contact

CHILD #1

Child #2

Child #3

Child #4

PAYMENT/REGISTRATION INFO (PLEASE READ):