Parent's Night Out
Times 5:00pm to 8pm
Parent (Mother)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Parent (Father)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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
$40.00
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$0.00
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: