Valentine's Date Night Registration

Child Information

Please fill this form out to the best of your ability. Any information that you can give us about your child will help us to better serve your child.





Parent/Guardian Information




Please e-sign your name after reading this covenant. I certify that all of the information in this form is accurate, to the best of my knowledge. I promise to pick my child up at 9:00 PM or before. I acknowledge that if there are any behavioral concerns, these will be handled by the volunteers and staff at KGPC. I acknowledge that should behavioral concerns require more than average correction, I will be contacted and expected to pick up my child immediately. Please do not drop off your child if your child has exhibited any symptoms of illness.Please type your name below to signify that you agree to this covenant. We can't wait to hang out with your child!


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