Name: Parents' Night Out Registration
SKU: 3481
Availability: InStock

The cost of Parents’ Night Out is $10.00 per child each month. Registration closes the Wednesday before each date.

Please provide diaper bags and a change of clothes (if applicable).

Children must eat before they come or bring their dinner in a lunchbox (no microwave available).

Number of Children To Be Registered*

First Child Information

Child's Full Name*

First Last

Gender

Male
Female

Date of Birth*

Age*

Grade*

Child 1 Dates*

Dates to Register for*

Second Child Information

Child's Full Name*

First Last

Gender

Male
Female

Date of Birth*

Age*

Grade*

Child 2 Dates*

Dates to Register for*

Third Child Information

Child's Full Name*

First Last

Gender

Male
Female

Date of Birth*

Age*

Grade*

Child 3 Dates*

Dates to Register for*

Fourth Child Information

Child's Full Name*

First Last

Gender

Male
Female

Date of Birth*

Age*

Grade*

Child 4 Dates*

Dates to Register for*

Parent or Guardian Contact Information

Parent's/Guardian's Full Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

If unable to reach, please contact:*

at

Emergency Medical Information

Child's Physician's Name*

Child's medical concerns of which we should be aware:*

Allergies/Dietary Restrications*

Medical Treatment Consent*

I authorize medical treatment for my child in case of an accident or illness if the parent or guardian cannot be located and an emergency situation arises.

There are no refunds given for this program.

Signature

Parent/Guardian Digital Signature*

Date*

Parents’ Night Out Registration

Parents’ Night Out Registration

First Child Information

Second Child Information

Third Child Information

Fourth Child Information

Parent or Guardian Contact Information

Emergency Medical Information

Signature

Parents’ Night Out Registration

First Child Information

Second Child Information

Third Child Information

Fourth Child Information

Parent or Guardian Contact Information

Emergency Medical Information

Signature

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