mARCH Parents’ night out
registration

If YOU REGISTERED FOR THE FEBRUARY PARENTS’ NIGHT OUT, NO NEED TO REGISTER AGAIN. WE HAVE YOUR REGISTRATION INFORMATION.

iF more than two children are to be registered, please complete and submit another form.

Please note: this parents’ night out is for children 3 years old through 6th grade.

CHILD(REN) INFO
Please complete the following information about the child/children to be registered
CHILD ONE
Child One: Name *
Child One: Name
Child One: Birthdate *
Child One: Birthdate
CHILD TWO
Child Two: Name
Child Two: Name
Child Two: Birthdate
Child Two: Birthdate
NOTE: If there are more than two children to be registered, please submit a second form for the additional children.
PARENT/CAREGIVER INFO
Please complete the following informtion as it applies to the child(ren)'s parent(s) or primary caregiver.
Parent(s)/caregiver name *
Parent(s)/caregiver name
Parent/Caregiver phone number *
Parent/Caregiver phone number
Home phone
Home phone
Home address *
Home address
IN CASE OF EMERGENCY
Emergency contact *
Emergency contact
Emergency contact phone *
Emergency contact phone