Sweetheart Dinner and Dance

REGISTRATION

$50/couple and $60/couple +Childcare incl: dinner for child(ren).
First person in the couple*

First NameLast Name
Second person in the couple*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Married or Dating?*

MarriedDating
If married, when is your anniversary?
If dating, how long have you been together?
Dietary needs for first person:*

NoneGluten FreeDairy Free
Dietary needs for second person:*

NoneGluten FreeDairy Free
Inviting friends? Names?
Did someone invite you? Who?
Request to sit at the same table. (8 total per table) We'll do our best to accommodate your preference.
Child care needed 0-5th grade?*

Yes - fill out info for each childNo - scroll to the end to SUBMIT
The following info is required for Childcare:
Child #1 - Name

First NameLast Name
Age
Dietary needs for Child #1

NoneGluten FreeDairy FreeIf your child requires other needs, please bring food specific for him/her and labeled.
Special needs?

YesNo
If yes, share with us how we can make your child's night fun and a good experience.
Child #2 - Name

First NameLast Name
Age
Dietary needs for Child #2

NoneGluten FreeDairy FreeIf your child requires other needs, please bring food specific for him/her and labeled.
Special needs?

YesNo
If yes, share with us how we can make your child's night fun and a good experience.
Child #3 - Name

First NameLast Name
Age
Dietary needs for Child #3

NoneGluten FreeDairy FreeIf your child requires other needs, please bring food specific for him/her and labeled.
Special needs?

YesNo
If yes, share with us how we can make your child's night fun and a good experience.
Child #4 - Name

First NameLast Name
Age
Dietary needs for Child #4

NoneGluten FreeDairy FreeIf your child requires other needs, please bring food specific for him/her and labeled.
Special needs?

YesNo
If yes, share with us how we can make your child's night fun and a good experience.
After submitting your registration - RETURN TO WEBSITE FOR PAYMENT: $50/couple and $60/couple + childcare (including dinner for child(ren).
Should be Empty:

REGISTRATION

The following info is required for Childcare:

After submitting your registration - RETURN TO WEBSITE FOR PAYMENT: $50/couple and $60/couple + childcare (including dinner for child(ren).