Silver Wings Parents Night Out Child InformationName* First Last School*Grade*Kindergarten1st2nd3rd4th5th6th7th8thParent/Guardian InformationParent/Guardian Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home Phone*Mobile Phone*Emergency Contact InformationEmergency Contact Name*Emergency Contact Phone*HHS Silver Wings Release of Liability: I give permission for my daughter to participate in the Hebron HS Silver Wings Parents Night Out on October 14, 2017. I agree to and understand that although precautions will be taken to ensure the safety of my child, any injury that may occur during the event is not the responsibility of HHS or the Silver Wings Booster Club. Release of Liability* I agree HHS Silver Wings Photo Release : HHS Silver Wings is a community outreach program and may reproduce and publish photographs taken on October 14, 2017. I agree that my child’s picture may be used in connection with articles concerning the Parents Night Out or with advertisement of future clinics. Photo Release* I agree Number of Children*OneTwoThreeFiveSixSevenEightCommentsThis field is for validation purposes and should be left unchanged.