PARENTS' NIGHT OUT • Journey Church

PNO payment of $5 per child or $15 max per family must be taken online via credit card. Crafts and pizza orders are placed ahead of time with the head-count of registered kids so we cannot give refunds for cancellations or no-shows. REGISTRATION CLOSES MIDNIGHT ON WEDNESDAY, SEPTEMBER 17. Email Tiffany@ourjourney.com after that date to see if there are spots available, before registering.

All PNO volunteers, ages 18 and older, are background checked and approved through our Journey Kids Ministry. You will be emailed the PNO Guidelines the week prior to the event.

Date & Time

September 19, 2025 5:30 PM - 8:30 PM

Type

Price

Quantity

Individual Child

Price
$5.00

Quantity
Two children

Price
$10.00

Quantity
Three + children (max per family)

Price
$15.00

Quantity

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Individual Child 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number *

Email Address *

CHILD REGISTRATION

Child 1 - First Name

Child 1 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 2 - First Name

Child 2 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 3 - First Name

Child 3 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 4 - First Name

Child 4 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

If you have registered for previous PNO's, you do not need to complete the information below. Just scroll down and click submit. If this is your first PNO at Journey, please complete the following information. Thank you!

Child(rens) Doctor Name

Doctor Phone #

EMERGENCY CONTACTS / RELEASE LIST

If parents cannot be reached, we will contact your emergency contacts. By listing the following persons below, you are authorizing Journey Church to allow your child(ren) to leave the facility with ONLY these individuals. Please let them know we will require proof of identification. If you are divorced/separated, please bring us a copy of the Custody order signed by the judge, showing us who has custody of the child at any point in time.

Emergency Contact Name

Emergency Contact #

Emergency Contact Name

Emergency Contact #

PERMISSIONS

Permission is given to Journey Church for the following:

Call an ambulance in case of emergency.

Take my child to a physician or hospital if I am unable to be reached.

Please give my child his/her prescription when instructed (as prescribed by childs physician).

Give non-prescribed medication as instructed by parent.

Journey Church has my permission to use photographs and video of my children participating in ministry activities for printed materials, in church viewing, and website postings. I understand that my child's name will not be used to identify my child in the publishings. If I would like to withdraw my permission, I may do so at any time.

Yes, I give permission.

No, I do not give permission.

I give my consent for the local hospital to secure any and all necessary emergency medical care for my child(ren). I also understand that any medical expenses necessary are my responsibility.

Yes, I give consent.

No, I do not give consent.

By typing my name below, I agree to all the above permissions as well as I understand that all efforts will be taken to ensure my childs safe participation at Journeys events. I release all adult supervisors and Journey Church from responsibility for any accidents/injuries during church sponsored activities.

Parent/Guardian First & Last Name

Two children 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number *

Email Address *

CHILD REGISTRATION

Child 1 - First Name

Child 1 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 2 - First Name

Child 2 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 3 - First Name

Child 3 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 4 - First Name

Child 4 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

If you have registered for previous PNO's, you do not need to complete the information below. Just scroll down and click submit. If this is your first PNO at Journey, please complete the following information. Thank you!

Child(rens) Doctor Name

Doctor Phone #

EMERGENCY CONTACTS / RELEASE LIST

If parents cannot be reached, we will contact your emergency contacts. By listing the following persons below, you are authorizing Journey Church to allow your child(ren) to leave the facility with ONLY these individuals. Please let them know we will require proof of identification. If you are divorced/separated, please bring us a copy of the Custody order signed by the judge, showing us who has custody of the child at any point in time.

Emergency Contact Name

Emergency Contact #

Emergency Contact Name

Emergency Contact #

PERMISSIONS

Permission is given to Journey Church for the following:

Call an ambulance in case of emergency.

Take my child to a physician or hospital if I am unable to be reached.

Please give my child his/her prescription when instructed (as prescribed by childs physician).

Give non-prescribed medication as instructed by parent.

Journey Church has my permission to use photographs and video of my children participating in ministry activities for printed materials, in church viewing, and website postings. I understand that my child's name will not be used to identify my child in the publishings. If I would like to withdraw my permission, I may do so at any time.

Yes, I give permission.

No, I do not give permission.

I give my consent for the local hospital to secure any and all necessary emergency medical care for my child(ren). I also understand that any medical expenses necessary are my responsibility.

Yes, I give consent.

No, I do not give consent.

By typing my name below, I agree to all the above permissions as well as I understand that all efforts will be taken to ensure my childs safe participation at Journeys events. I release all adult supervisors and Journey Church from responsibility for any accidents/injuries during church sponsored activities.

Parent/Guardian First & Last Name

Three + children (max per family) 0

Parent/Guardian First Name *

Parent/Guardian Last Name *

Mobile Number *

Email Address *

CHILD REGISTRATION

Child 1 - First Name

Child 1 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 2 - First Name

Child 2 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 3 - First Name

Child 3 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

Child 4 - First Name

Child 4 - Last Name

Date of Birth

Allergies or Special Needs

Child's Classroom

Infants-18mo

Toddlers/2s

Preschool

Kindergarten-2nd Grade

3rd-5th Grade

If you have registered for previous PNO's, you do not need to complete the information below. Just scroll down and click submit. If this is your first PNO at Journey, please complete the following information. Thank you!

Child(rens) Doctor Name

Doctor Phone #

EMERGENCY CONTACTS / RELEASE LIST

If parents cannot be reached, we will contact your emergency contacts. By listing the following persons below, you are authorizing Journey Church to allow your child(ren) to leave the facility with ONLY these individuals. Please let them know we will require proof of identification. If you are divorced/separated, please bring us a copy of the Custody order signed by the judge, showing us who has custody of the child at any point in time.

Emergency Contact Name

Emergency Contact #

Emergency Contact Name

Emergency Contact #

PERMISSIONS

Permission is given to Journey Church for the following:

Call an ambulance in case of emergency.

Take my child to a physician or hospital if I am unable to be reached.

Please give my child his/her prescription when instructed (as prescribed by childs physician).

Give non-prescribed medication as instructed by parent.

Journey Church has my permission to use photographs and video of my children participating in ministry activities for printed materials, in church viewing, and website postings. I understand that my child's name will not be used to identify my child in the publishings. If I would like to withdraw my permission, I may do so at any time.

Yes, I give permission.

No, I do not give permission.

I give my consent for the local hospital to secure any and all necessary emergency medical care for my child(ren). I also understand that any medical expenses necessary are my responsibility.

Yes, I give consent.

No, I do not give consent.

By typing my name below, I agree to all the above permissions as well as I understand that all efforts will be taken to ensure my childs safe participation at Journeys events. I release all adult supervisors and Journey Church from responsibility for any accidents/injuries during church sponsored activities.

Parent/Guardian First & Last Name

Total

$0.00

Time Remaining