Event Registration

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Date Night June 24, 2022 on Friday, June 24, 2022 @ 6:00 PM

*How did you hear about Date Night?
If you were invited by a friend, who?
*Have you participated in Date Night before?
*Do you attend Shades Mountain Baptist Church?
If you attend another church, which one?
*Your Date of Birth:
*Your Date's Name:
*Your Date's Date of Birth:
List names and birthdates for all children needing childcare, each separated by a comma.  
Also include current school grade if Kindergarten - 6th grade. 
(ex. John Doe, 8/18/2010, 2nd grade)
List any allergies or special needs for any children listed above.
List the name of a friend to be placed in class with each child (limit one per child).
List the names of your responsible 7th-12th graders interested in helping with childcare.
We get in touch with you about their placement.
Please contact Sarah Kent, Minister to Preschool, with questions specific to childcare.