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Our Parent's Night Off Events provide a safe space for your kids to make new friends, have fun and cultivate new skills. With dinner included for your kid(s), we might just be the best CAMP option in town. ? A Typical Evening: ? 5:00-5:15pm Drop Off 5:15-5:30pm Welcome Game 5:30-6:15pm Arts & Crafts, Science or Cooking Activity 6:15-6:45pm Dinner *Included 6:45-7:30pm Surprise Activity 7:30-9:00pm Popcorn & Movie Time
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
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Last Name:
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Type
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Caregiver
Father
Guardian
Mother
Parent
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
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Emergency Contact Info (Not Contact #1 or #2)
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Birth Date:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
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Medications (Leave blank if NONE):
Photo Consent :
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Add New Student #2:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
*
Medications (Leave blank if NONE):
Photo Consent :
*
Add New Student #3:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
*
Medications (Leave blank if NONE):
Photo Consent :
*
Add New Student #4:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
*
Medications (Leave blank if NONE):
Photo Consent :
*
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
*
Medications (Leave blank if NONE):
Photo Consent :
*
Additional Information:
Acknowledgement of Risk/Liability Waiver
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I understand and agree that participating in a Riviera Kids Club Event such as Parent’s Night Off, there is the possibility of injury. I voluntarily agree to assume all risks and responsibility for any injury or accident, which might occur to my child during a Riviera Kids Club Event such as Parent’s Night Off. I agree to not hold Riviera Kids Club, any teacher, assistant, counselor or facilities liable for any injury including, but not limited to personal injury, illness, disability, loss, or death that may occur before, during or after any given Riviera Kids Club Event.
I've read the above and agree.
Photo & Video Release
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I give my consent to Riviera Kids Club to use any media or medium of me, my child and/or family for posting on Riviera Kids Club’s social media pages as well as for advertising and/or promotional purposes.
I've read the above and agree.
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