Clone of February Kids Night Out!

Kids Night Out!

Saturday February 14th Ages 2-10 Time: 5pm-9pm Cost: $60 for Members and $75 for Non-Members Dinner Included!
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Second Child's Name

First NameLast Name
Second Child's Birth Date

MonthDayYear
Parent/Guardian Information
Name*

First NameLast Name
Best Contact Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Meal Selection
Childs Main Course*
Childs Side*
Childs Drink*
Second Childs Main Course
Second Childs Side
Second Childs Drink

Will you need extended care? If yes, please select when you will be back for pick up! *Payment for extended care will be collected at drop off! Please plan on bringing a check or cash for your child's extended care! $20/hr per child or $25/hr per family

Payments are due at time of registration and no refunds will be given once registration is submitted.*

Member

$60.00 Quantity

Non-Member

$75.00 Quantity

Total

$0.00

Kids Night Out!