Parents Night Out!

Parents Night Out!

Please fill out this form to register for the event on October 16th, 6–10 PM. Join us for an action packed night where kids will enjoy a pumpkin painting contest, face paint, games, dancing, pizza, and a movie while parents enjoy a night out.
Pricing is $15 for the first child and $10 for each additional child. Select the option that matches your family size below.
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child's Full Name
If more than 3 please add their details in Special Instructions
Child's Full Name
Child's Full Name
Child's Age
Child's Age
Child's Age
Emergency Contact Full Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies or Medical Notes
Special Instructions
I agree to emergency care for my child if I cannot be reached.
Payment is required to complete registration. Your spot is only confirmed once payment is submitted.
Payment

1st child registration

Registration for first child

$15.00 Quantity
Item subtotal:

Additional Children

Registration for additional children

$10.00 Quantity
Item subtotal:

Total