Parents' Night Out Child Registration Form
Please fill in the form below.
Name of Child
*
First Name
Last Name
Grade of Child
*
K-1, 2-3, 4-5
Name of Parent/Guardian
*
First Name
Last Name
Parent/Guardian Phone Number
*
Format: (000) 000-0000.
Name of Additional Emergency Contact
*
First Name
Last Name
Relation to Child
Phone Number of Additional Emergency Contact
*
Format: (000) 000-0000.
Allergies, Medications, Other Medical Alerts or Concerns
*
Pizza (click "Other" if Your Child is Allergic)
Cheese
Pepperoni
Either
Other
Submit
Should be Empty: