Kennesaw Kids Parents' Night Out Registration Form
April 19 6pm-9pm
Child Name
First Name
Last Name
Child Birthdate
-
Month
-
Day
Year
Date
Child Age
Please list any allergies and reaction if exposed
Child 2 Name
First Name
Last Name
Child 2 Birthdate
-
Month
-
Day
Year
Date
Child 2 Age
Please list any allergies and reaction if exposed
Child 3 Name
First Name
Last Name
Child 3 Birthdate
-
Month
-
Day
Year
Date
Child 3 Age
Please list any allergies and reaction if exposed
Parent 1 Name
First Name
Last Name
Parent 2 Name
First Name
Last Name
Parent 1 Email
example@example.com
Parent 2 Email
example@example.com
Parent 1 Phone Number
Please enter a valid phone number.
Parent 2 Phone Number
Please enter a valid phone number.
Emergency Contact 1 Name
First Name
Last Name
Emergency Contact 1 Phone Number
Please enter a valid phone number.
Emergency Contact 2 Name
First Name
Last Name
Emergency Contact 2 Phone Number
Please enter a valid phone number.
Authorized Pick Up Person(s)
Registration Fee
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Parents' Night Out Registration Fee
$25 for first child, $20 for each additional child
$
25.00
Credit Card
Submit
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