Parent's Night Out & Saturday Care Registration Form

Parent's Night Out & Saturday Care Registration Form
General Parent/Guardian and Child Information
Are you signing your child up for the next upcoming Parent's Night Out, Saturday Care, or both?*

Just Parent's Night OutJust Saturday CareBoth
Upcoming Parent's Night Out and Saturday Care Schedule:

use this field to fill in the upcoming schedule of both services

Registration Fees:

Parents Night Out $25

Saturday Care $40

Both services together $55
I understand that I will re-register each time my child attends Parent's Night Out and Saturday Care. I also understand that Saturday Care is only available every other Saturday.*

Yes
Parent/Guardian Name*

First NameLast Name
Parent/Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Age*
Emergency Contact*

First NameLast Name
Emergency Contacts Relationship With Child*

ParentSiblingGrandparentOther
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Terms and Conditions
I understand that my child's spot has not been reserved until the registration payment has been made by cash, check, or money order ONLY.*

Yes
Please read the following carefully, and pick the answer that corresponds with the services that you are enrolling your child in via this form.
I understand that if I am registering my child for both Parent's Night Out and Saturday Care, the registration fee for both is $55. Individually, Parent's Night Out requires a $25 registration fee, and Saturday Care requires $40.*

Yes, I understand that by enrolling my child in both services, I will owe $55 for the registration fee.Yes, I understand that by enrolling my child in just Parent's Night Out, I will owe $25 for the registration fee.Yes, I understand that by enrolling my child in just Saturday Care, I will owe $40 for the registration fee.
I understand that there will be a late fee of $1 per minute if my child is not picked up on time.*

Yes
Should be Empty:

General Parent/Guardian and Child Information