Parents' Night Out Registration Form September 26, 2026-5:30 pm to 9:30 pm

Parents' Night Out Registration Form September 26, 2026-5:30 pm to 9:30 pm

Please fill in the form below.
Name of Child

First NameLast Name
Age of Child
Limited to ages 3-12
Name of Parent/Guardian

First NameLast Name
Parent/Guardian Phone Number
Format: (000) 000-0000.
Parent/Guardian Email:
example@example.com
Name of Additional Emergency Contact

First NameLast NameRelation to Child
Phone Number of Additional Emergency Contact
Format: (000) 000-0000.
Allergies, Medications, Other Medical Alerts or Concerns
Pizza (click "Other" if Your Child is Allergic)

Other
Payment
The cost for Pizza, PJs and a Movie is $35/child.

Spots are limited and will be filled on a first come-first serve basis. Payment is required to secure your child's spot for the event. I understand that fees are nonrefundable due to limited availability and planning requirements.

After signing and submitting this form, you will be directed to the payment link.
Signature
Should be Empty:

Payment