Teen/Tween Social & Parent Night Out Application

Teen/Tween Social will return Friday, September 2, 2022.

Check back here to register in early August, 2022.

Have a great summer & we’ll see you this fall!

Participant Criteria:

Program Guidelines:

Events are held at The Family Life Center at Christ Church-Sugar Land, 3300 Austin Pkwy,
Sugar Land, TX 77479
Applications must be received 7 days prior to each event.
Max 20 participants per event.
Additional registrations received will be placed on a waiting list.

NOTE: We are not equipped to serve those who are medically fragile, or in need of intensive behavior management.

If you have any questions, you may contact Karri Axtell at kaxtell@arcoffortbend.org or 281-494-5924.

Family Information
Parent/Guardian 1- First, Last Name*
Parent/Guardian 2 - First, Last Name
Home Phone*
Parent/Guardian 1 Cell
Parent/Guardian 2 Cell
Parent/Guardian Email*
Number to contact first*
- Home Phone
- Parent/Guardian 1 Cell
- Parent/Guardian 2 Cell
Select primary contact number that is most likely to get a response
Emergency Contact (other than parent)
Emergency Contact Name*
Relationship to Participant*
Home Phone*
Work or Cell Phone

Health Information
Primary Diagnosis*
Seizures*
- Yes
- No
Seizure Type
Secondary Diagnosis
Allergies*
- None
- Latex
- Insect Bites
- Foods
- Medications
- Penicillin
- Other
Please specify allergies to foods, medications, or other items
ONLY Prescription medication needed during the event will be administered by the Activity Director. All medications MUST be in the original container prescribed to the participant. No OTC meds will be administered.
List Medications (Name - Dosage - Frequency - Special Instructions)

Behaviors (Important to be specific to help with volunteer matching.)
1. Is there anything important to know about your child’s behaviors in a group setting?
2. Is there anything that is calming or comforting to your child if they become upset or over stimulated?
3. Are there any behaviors your child might exhibit and how are they best managed?

Participant Information