Registration

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Get your kids moving at Altius Special Events! Parents' Night Out is co-ed and non-members are welcome. Each PNO features games and activities, along with bucket rides, trampoline, and obstacle courses. All activities are closely supervised by our instructors. Cheese pizza and beverage are provided at 8:00pm. Cost: 1 Child $45, 2 Siblings $70.00, and additional siblings $20/each Drop off/pick up: Please arrange to drop off and pick up your child(ren) within ten minutes of the start/end of the event. Children must wait inside the building for their ride. Adults must sign out their child at the front desk. Payment/Cancellation Policy: Upon receipt of your registration, Altius will process your payment, including sibling discounts and coupons, using the credit card information provided. You will receive an email to confirm payment and registration. A full account credit will be issued up to 72 hours before the event. Within 72 hours, a 50% account credit will be issued.

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:*	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Name & Phone*

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	School:*	Grade Level:
	Medical Conditions:
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):

Questions/Options:


Child's name (first & last if different than parent), age, and birthdate
Child's name, age, and birthdate
Child's name, age, and birthdate
Child's name, age, and birthdate
Does your child(ren) have any medical conditions or food allergies we should be aware of?
If yes, please describe
Do you have any coupons/discounts to apply?
If yes, please describe, including expiration date. Altius will apply the discount to your event fee.

Additional Information:

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