Parent's Night Out

Parent's Night Out!

March 14th, 2026

Ages 4 to 12

Hours: 4:30-8:30

Pizza dinner will be served!

Gluten Free Pizza will be available

Any questions, please email is at littleexplorerscrew@gmail.com

www.littleexplorersseattle.com
Student name*

First NameLast Name
Student birthday*

MonthDayYear
Date
Parent / Guardian 1*

First NameLast Name
Email*
example@example.com
Cell phone*

Area CodePhone Number
Parent / Guardian 2

First NameLast Name
Email
example@example.com
Cell phone

Area CodePhone Number
Emergency Contact if parents cannot be reached*

First NameLast Name
Cell phone*

Area CodePhone Number
Does your child have any allergies or health concerns?*
Does your child have any dietary restrictions?
Consent for medical treatment for your child:

I give permission for my child to be given emergency treatment by a licensed health care provider at the nearest emergency center. When I cannot be contacted, I authorize medical, surgical and hospital care, treatment and procedures to be performed for my child by a licensed health care provider when deemed necessary or advisable by a medical professional to safeguard my child’s health. I also give permission for my child to be transported by ambulance to an emergency center for treatment.
Please sign*

Clear
Permission for walks and trips to park

I give permission for my child to go on walks and to parks in the Green Lake neighborhood.
Please sign*

Clear
Please feel free to use the space below for any additional information.
*
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Parent's Night Out$40.00

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