Kids Night Out at IGNITE

kids Night Out at IGNITE Dance & Yoga

Hosted By Community Connections
Childs Name

First NameMiddle NameLast Name
Gender

MaleFemale
Childs Date of Birth

MonthDayYear
Date
Childs Name

First NameMiddle NameLast Name
Gender

MaleFemale
Childs Date of Birth

MonthDayYear
Date
Childs Name

First NameMiddle NameLast Name
Gender

MaleFemale
Childs Date of Birth

MonthDayYear
Date
Parent / Guardian Email
example@example.com
Phone Number
Mobile Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Kids Night Out

September 6thOctober 4thNovember 8th

Can your child be photographed for our social media page?

YesNo
Medical Information
Does the child have allergies including asthma?
Please explain on the field provided including any food the camper is allergic to

Contact Information in Case of Emergency
Name

First NameLast Name
Contact Number
Relation to child
Name

First NameLast Name
Contact Number
Relation to child

Payment

My Products

Kids Night

$55.00

Multi Child Discount 15% when registering multiple children

$46.75 Quantity

Enter coupon

Total

$0.00

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty: