Registration
Date night for you and fun night out for the kids. We will be doing crafts, games, pizza, cookie decorating, and more! Ages 5 and up are welcome to attend this event on 3310 South 2700 East. $20 for one child, $10 for additional sibling. You can pay with card or cash.
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
(Not Contact #1 or #2)
 
 
Students entered below will be added to your family's account
 
Additional Information:
 
 
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: