Parent's Night Out
Times 5:00pm to 8pm
Parent (Mother)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Parent (Father)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
First Child's Name
*
First Name
Last Name
Child's Age
*
Second Child's Name
First Name
Last Name
Age
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I agree that if my child needs immediate medical attention, Amici Trilingual Montessori may call 911 and transport my child to the nearest hospital.
*
Yes
No
If you arrive to pick up your child late after 8:10 pm Amici Trilingual Montessori will charge you $25 Write Acknowledge below.
*
Signature
Check Out
*
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next
( X )
Number of Children
$
30.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
Should be Empty: