Fellowship Church - Kid's Night Out

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But as many as received Him, to them He gave the right
to become children of God... John 1:12

Kid's Night Out
e-Registration

Second Friday of Each Month, 6 - 10 P.M.
at Fellowship Church

I am registering for the following months (check all that apply):

Parent First Name*
Parent Last Name*
Address Line 1*
Address Line 2
City*
State*
Zip Code*
Telephone*
Email Address
		Emergency Contact Information:
First Name*
Last Name*
Telephone*

Child #1 First Name*
Child #1 Last Name*

Child #2 First Name
Child #2 Last Name

Child #3 First Name
Child #3 Last Name

Child #4 First Name
Child #4 Last Name

Please list any allergies, special needs and comments:

300 Cromwell Street, Phillipsburg, New Jersey 08865
Voice: 908-859-6464 Fax: 908-213-0619 E-mail: pcadmin@ptd.net