Kids Night Out!
Saturday February 14th Ages 3-10 Time: 5pm-9pm Cost: $60 for Members and $75 for Non-Members Dinner Included!
Child's Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Second Child's Name
First Name
Last Name
Second Child's Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Parent/Guardian Information
Name
*
First Name
Last Name
Best Contact Number
*
E-mail
*
example@example.com
Emergency Information
Emergency Contact's Name
*
First Name
Last Name
Relationship
*
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Phone Number
*
Alt. Phone Number
Back
Next
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Meal Selection
Childs Main Course
*
Please Select
Cheese Pizza
Pepperoni Pizza
Mac and Cheese
Childs Side
*
Please Select
Carrots and Ranch
Fruit
Childs Drink
*
Please Select
Fruit Punch
Apple Juice
Grape Juice
Water
Second Childs Main Course
Please Select
Mac and Cheese
Cheese Pizza
Pepporoni Pizza
Second Childs Side
Please Select
Fries
Mixed Fruit
Second Childs Drink
Please Select
Fruit Punch
Apple Juice
Grape Juice
Water
Back
Next
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
Please Select
10pm
11pm
None Needed I will pick up at 9pm!
Payments are due at time of registration and no refunds will be given once registration is submitted.
*
prev
next
( X )
Member
$
60.00
Quantity
0
1
2
Non-Member
$
75.00
Quantity
0
1
2
Credit Card
Submit Form
Should be Empty: