Registration

Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Relationship*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info
(NOT Guardians)
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Date of Birth*
Have you attended Late Nite before? *If this is your first time we will need to check your ID to verify age**
 
Additional Information:
 
 
Other Questions/Comments: