Registration

$30 7:00 - 10:00 pm. Let your kids have an amazing time with us while you have quiet time for yourself! Trampoline fun, foam pit fun, games, activities, with drink & snack provided! Receive 1 friendship bracelet with registration, purchase extra for $2 each. Please note that when registering, the system automatically charge a fee of $30. No refunds after registration.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Parent's Information
First Name:* Last Name: *
Parent/Self if over 18*
Home Phone:* Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Who referred you to Parents Night Out?
Would you like to purchase any additional bracelets? If so, how many?
 
Additional Information:
 
Assumption of Risk/Release of Liability
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I've read the above and agree.
 
Medical Emergencies
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I've read the above and agree.
 
Photo/Video Release
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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:*