September 30th Kids Night At The Farm
Please fill out the following form in full to register for Kids Night At The Farm. September 30th, 5:30pm-8:30pm. Kids Night At The Farm is for age 5-14. You will be emailed a receipt upon completion.
Child Information
Child's Name #1
*
First Name
Last Name
Child's Age
*
Child's Name #2
First Name
Last Name
Child's Age
Child's Name #3
First Name
Last Name
Child's Age
Parent/Guardian Information
Parent's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Emergency Information
Two Emergency Contacts- Name, Relationship, & Phone Numbers
*
Special Notes & Medical Info (Allergies, etc.)
Notes To Blue Heron Riding Academy
How did you hear about us?
Kids Night Out Payment & Details
Cost is $30/child and includes a pizza dinner. Payment for all children being registered must be submitted with registration in order to hold the spots. Kids Night Out payments are not refundable. Please look for an email closer to the event date that will include event details and a link to a liability release to fill out prior to the event.
Kids Night Out Payment-
*
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Kids Night Out (per child)
$
30.00
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Total
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0.00
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