Parents' Night Out

Parent Name:

Email:

This address will receive a confirmation email

How many children are you registering?

1 2 3 4

Please list each child's name and age below.

Parent Phone Number:

Additional Emergency Contact Phone Number:

Is your child allergic to any foods or medicines? (Please list.) If so, will your child be bringing an Epi Pen?

To make this a better experience for your child, are there any special needs he/she has that we should plan to accomodate?

The cost for each child is $8. This covers the cost of dinner and needed supplies. You can pay through this form, or you can give cash to Ashley.

Payment ($8 per child)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Friday, February 13th, 5:30-8:00 PM

Drop off your kids for an evening of dinner, crafts, games, and fun - and enjoy some time to yourselves!

Cost: $8 per child (this covers the cost of dinner and supplies)

Register by February 8th!

Parents' Night Out

Description

Please Fix the Following