Canaan Christian Academy

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Kids Night Out Sign-Up & Emergency Form

Please complete the form below. Required fields marked *

Contact Information

Parent/Guardian First & Last Name*

Answer Required

Emergency phone (no spaces/dashes)*

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Second phone (no spaces/dashes)*

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Name of child*

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List any allergies

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Name of child

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List any allergies

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Name of child

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List any allergies

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Name of child

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List any allergies

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List number of pizza suppers wanted:

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List number of hot dog suppers wanted:

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Confirmation Email

Confirmation Email

Enter your email address here if you'd like to receive a confirmation upon submitting the form.

Email Required