Foster Care Respite Night Registration

We are so excited to serve your family at Kids Night Out! At Pathway we use an electronic check-in system for kiddos, Infants-12th grade, for different events. Please complete this form, before the upcoming Respite Night, and we will have your info entered into our check-in system.

If you have any questions please email us at fostercare@pathway.church.

*Address Line 1
Address Line 2
*City
*State/Province/Region
*Zip/Postal Code
*Which Respite Night Date are you registering for? 
*Name of local emergency contact:
*Phone number for emergency contact:
*Relationship of emergency contact to adult registering:
*Number of children participating in Kid's Night Out?
*Child 1 Full Name:
*Child 1 Date of Birth:
*Age of Child #1
*Child 1 Grade in school (if applicable):
*Child 1 Gender:
*Does child 1 have food allergies that require a special diet?
If yes, please list the child's allergy:
*What is the relationship of this child to the guardian?
*please note, all children in your family are welcome to attend
Child 2 Full Name:
Child 2 Date of Birth:
Age of Child #2
Child 2 Grade:
Child 2 Gender:
Does child 2 have food allergies that require a special diet?
If yes, please list the child's allergy:
What is the relationship of this child to the guardian?
*please note, all children in your family are welcome to attend
Child 3 Full Name:
Child 3 Date of Birth:
Age of Child #3
Child 3 Grade:
Child 3 Gender:
Does child 3 have food allergies that require a special diet?
If yes, please list the child's allergy:
What is the relationship of this child to the guardian?
*please note, all children in your family are welcome to attend
Child 4 Full Name:
Child 4 Date of Birth:
Age of Child #4:
Child 4 Grade:
Child 4 Gender:
Does child 4 have food allergies that require a special diet?
If yes, please list the child's allergy:
What is the relationship of this child to the guardian?
*please note, all children in your family are welcome to attend
Child 5 Full Name:
Child 5 Date of Birth:
Age of Child #5:
Child 5 Grade:
Child 5 Gender:
Does child 5 have food allergies that require a special diet?
If yes, please list the child's allergy:
What is the relationship of this child to the guardian?
*please note, all children in your family are welcome to attend
Child 6 Full Name:
Child 6 Date of Birth:
Age of Child #6:
Child 6 Grade:
Child 6 Gender:
Does child 6 have food allergies that require a special diet?
If yes, please list the child's allergy:
What is the relationship of this child to the guardian?
*please note, all children in your family are welcome to attend
*Do you need a Respite servant to contact you concerning special accommodations?
Submit Form