Registration
2 openings left in this event!

Parents Night Out - 6:30-9:30pm ~ Ages 5-13 ~ $25.00 (10% Sibling Discount)
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: *
 
 
Students entered below will be added to your family's account
 
Questions/Options:
How did you hear about us?*
Is your child Gluten Free?*
 
Additional Information:
 
Release of Liability
  (Show-Hide Details)
I've read the above and agree.
 
Assumption of Risk
  (Show-Hide Details)
I've read the above and agree.
 
Photo & Video Release
  (Show-Hide Details)
I've read the above and agree.
 
Insufficient Enrollment Disclaimer
  (Show-Hide Details)
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:*