Mom’s Night Out

Date: TBD
Time: 6:00 – 8:30 PM (doors open at 5:30 PM)
Location: Down Syndrome of Louisville
Address: 5001 S. Hurstbourne Parkway, Louisville, KY 40291

Hey mom, when was the last time you had a manicure, a massage, or simply enjoyed a meal with friends?

Brought to you by Barren Heights, Critically Loved, Down Syndrome of Louisville, Face It with Kosair Charities, and FEAT of Louisville is a very special Mom’s Night Out! Dinner will be provided and activities include massages, crafts, makeup/nail makeovers, and a pound class by local professionals – because a healthy family starts with a healthy mom!

APPLY TODAY because spots are limited!

*Please note: this year, we’d like to reserve this event for Mom’s who have never attended this event before in order to serve more mothers in the community. So, if you have attended a Mom’s Night Out in the past, please take a look at these other events to sign up for!

*Note for Barren Heights Moms: This event is different from any Mom’s “Night Out” events you have attended at Barren Heights!

Have you previously attended this specific Mom's Night Out event? (Partnered event with Barren Heights, Critically Loved, FEAT, and Down Syndrome of Louisville)*
First and Last Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone Number*

Format: (xxx) xxx-xxxx
Which organizations are you affiliated with?*
Food Restrictions (if any)*
Do you have a child with a physical or developmental disability?*
- Yes
- No
Please list your child's specific diagnosis.*
All application information is kept confidential. Application information may be shared with retreat volunteers so they are better equipped to serve your family. This information will not be distributed or used for marketing purposes.

Hold Harmless Agreement

By checking the boxes below you are agreeing on behalf of your family to an electronic signature.
Please check if you agree with the following statements:*
- I give my consent that the information given at registration may be communicated with leaders and volunteers for the purpose of being equipped to provide the best care and assistance possible to my family.
- I give my consent that photographs, interviews and audio/visual recordings during the course of the event may be used by the Mom's Night Out sponsoring organizations for training, promotion, and fundraising.
- I release the Mom's Night Out sponsoring organizations, its directors, and volunteers from all actions, damages, or personal injuries which may occur to me or a member of my family. I understand that in the event of a minor injury, I, or a member of my family may receive first aid treatment. I will be informed as soon as possible of any injury or condition of one of my family members and will be responsible thereafter for their care. In the event of an emergency, injury, or illness, emergency medical services and I will decide the best course of action. If the leaders are unable to reach me, I authorize them to take whatever action is necessary for the safety and health of my family members.
- I understand that in order for everyone to experience a sense of calm, peaceful relaxation, this event is an alcohol, drug, and smoke-free environment.
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Mom’s Night Out

Mom’s Night Out

Hold Harmless Agreement

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