Valentine & Dine Sign Up
Join us for dinner and entertainment on Valentine's Day! Please fill out the form below to reserve your spots.
Full Name
*
First Name
Last Name
Spouses Name (If applicable)
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Preferred Main Course
*
Please Select
Chicken Alfredo
Baked Ziti
Preferred Main Course
Please Select
Chicken Alfredo
Baked Ziti
Preferred Dessert
*
Please Select
Cheesecake
Strawberry Shortcake
Preferred Dessert
Please Select
Cheesecake
Strawberry Shortcake
Childcare
*
Please Select
Yes
No
Special Requests or Dietary Restrictions
Tickets
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Dinner for 2
$
50.00
Quantity
1
2
3
4
5
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7
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10
Dinner for 1
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Childcare
One child
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Multiple Children
2 or more children
$
20.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
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