Registration
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Drop your kids off the first Friday of every month and enjoy a night out! Structured games and activities, gymnastics, open gym time and Sugar River Pizza are all included in our Adventure Nights! Pricing: 1st Child $50, additional siblings $20 each! We will adjust the sibling discount after you register.
Event:
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Family Information
First Name:
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Last Name:
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Type
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Caregiver
Father
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Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
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State:
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Zip:
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Emergency Contact Info (Not Contact #1 or #2)
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
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Last Name:
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Student Gender:
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Birth Date:
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(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
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Student's First Name:
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Student Gender:
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Birth Date:
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #3:
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Student's First Name:
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Last Name:
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Student Gender:
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Birth Date:
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #4:
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Student's First Name:
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Last Name:
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Student Gender:
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Birth Date:
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Student Gender:
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Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Questions/Options:
Allergies/Medical Concerns:
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Is there anyone other than yourself authorized to pick up your children from Capital Adventure Night?
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Yes
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If yes, please provide us with Name, Relationship, Phone :
Additional Information:
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Credit Card Verification:
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Name as it appears on card:
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Nickname:
Card Expiration Month:
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Exp Year:
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MD
ME
MI
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MT
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NH
NJ
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NV
NY
OH
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OR
PA
RI
SC
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TN
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UT
VA
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Zip:
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