Registration
Drop the kids off for a fun evening while you have some peace and quiet! Whether you'd like to get some shopping done, go on a date night, clean the house in peace or just take a nap, we've got you covered! We'll have fun enjoying theater games, crafts and we'll have a pizza dinner together!
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 Info*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Does your child have any special needs or allergies we should know about?
Please list any dietary restrictions. (If your child cannot have cheese pizza, we encourage you to send a dinner for them.)
 
Additional Information:
 
Wellness Policy
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I've read the above and agree.
 
Photo/Image Release
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I've read the above and agree.
 
Assumption of Risk
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*