Free Drop In Kids Night Out: December 5th

Free Drop In Kids Night Out: December 5th

Please fill out the below form to ensure safety and understanding of child prior to Kid's Night out. Please fill out (1) form per child attending. Please keep in mind this is a Drop In Kid's Night Out, as we are expecting parents to enjoy themselves at Castaways Tiki Bar next door or no more than 5 minutes away in case of emergency.
General Information

- All children attending must be 3+ years old and bathroom independent. - RSVP Required for participation - Dinner will be served around 6:20pm, please note whether to expect your child or not through choice selection!
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Parent Name*
Mobile Number*
Email Address*
example@example.com
Dinner Selection (served at 6:20 pm, all selections come with french fries)*

Chicken TendersGrilled CheesePeanut Butter & JellyWe will be arriving after dinner is served
Please provide any allergies and dietary needs/restrictions your child has:*
Please provide any medical or behavioral information that will be helpful to our staff to ensure the best experience for your child: *
How did you hear about Explorium Fest?*
Emergency Contact Information
Emergency Contact Name *

First NameLast Name
Additional Emergency Contact Phone Number*
Relationship to Child*
Signature*

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General Information