About This Event

Please read thoroughly

  • Friday Nite Kidz Klub  is designed to give parents or guardians a 2 ½ hour night out! And it provides a fun experience for all of your children ages 6 months to 17 years. Activities include a variety of games, crafts, snacks, and more. We will also have a special needs sensory calming room.
  • Limited to the first 10 families to register. A waitlist will be formed if we exceed that number. 
  • Please complete one form for each child with special needs. 
  • We do provide a variety of healthy snacks and beverage, but we do not provide dinner. If bringing a meal for your child(ren), be sure to clearly label it with their name and leave it at the check-in table.
  • This event is free. All we ask is for each family to bring a healthy, nut-free snack or beverage (such as Honest juice pouches) to share. Thank you!


Registration Form - New Family

ONE FORM PER CHILD WITH SPECIAL NEEDS




Age should be between 2 and 17

  • Please take care of toileting needs before dropping off child. We do not provide diapers. Parent may be called for bowel movement.

PARTICIPATION AGREEMENT FOR 2024

Despite our best efforts to keep your children safe, Creekside Church and All Access cannot guarantee their safety at this or any event. 

PLEASE READ THE FOLLOWING STATEMENTS OF RESPONSIBILITY CAREFULLY AND THEN AGREE THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO THE PROVISIONS.


I acknowledge that participation in the activity described on this form involves risk to any participant listed above and to the parent/guardian of any participant who is a minor.

I acknowledge that risks may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

I accept personal financial responsibility for any injury or other loss sustained during transportation to and from the activity, as well as for any medical treatment rendered to the participant(s) that is authorized by Creekside Church or its agents, employees, volunteers, or any other representatives (collectively referred to as the "activity sponsor").

I release and promise to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant(s), or otherwise.

If a dispute over this agreement or any claim for damages arises, I agree to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.

In case of an emergency or accident, I understand Emergency Medical Services may be summoned via 911 if needed. I authorize said EMS to administer any medical treatment, medication, or appliance deemed necessary by the EMS attendants. I also authorize transportation by EMS to the nearest appropriate medical facility, as determined by EMS. I understand that I will be responsible for payment of all EMS, hospital, and physician charges for emergency services to my child(ren).

I have fully disclosed to All Access Church Consulting all pertinent facts about my child(ren)'s special needs and accept full responsibility for missing information.
Parents may be called to pick up their child if they fail to disclose all information needed to properly and safely care for the child.

I will supply all diapers/wipes for my child(ren), as well as any special food, drinks, snacks they may require.

I give permission for my child(ren) to be photographed or videotaped for promotional purposes.

(As we strive to reach as many families as possible, we may publicize this program through video, websites, and other media in a positive manner. The use of your name, your child's name and/or photo is voluntary. If you are willing to participate in our effort to help other families learn about our special needs ministry, please check the box)

THIS AGREEMENT IS IN AFFECT FROM JANUARY 1, 2024 THROUGH DECEMBER 31, 2024.



Questions? Text Dan Adragna at 916.390.2900 or  email [email protected].

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