PARENTS' NIGHT OUT CHILD REGISTRATION **For Pre-k and K-8th students** Para estudiantes de Pre-K y K-8 grado** (Amistad Auditorium)
Please fill in the form below.
Name of Child
*
First Name
Last Name
Child Classroom
Please Select
Prek
Kinder
Kinder/1
1/2
3
4/5
6/7/8
Email
*
example@example.com
Name of Parent/Guardian
*
First Name
Last Name
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Name of Additional Emergency Contact
*
First Name
Last Name
Relation to Child
Phone Number of Additional Emergency Contact
*
-
Area Code
Phone Number
Allergies, Medications, Other Medical Alerts or Concerns
*
Pizza (click "Other" if Your Child is Allergic)
*
Cheese
Pepperoni
Hawaiian
Other
Fee: $40 one child $30 siblings
My Products
*
prev
next
( X )
One child
$
40.00
Siblings
$
30.00
Total
$
0.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Signature
*
Submit
Should be Empty: