Registration
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Parents Night Out is held on select Saturdays from 6:00 - 9:00 pm. During the time we will have structured gym play, games, and pizza dinner. (you may bring your own dinner if you choose). Please bring a water bottle with your child Kids must be at least 3 years old and potty trained to attend. Parents MUST preregister, the gym can NOT offer Drop Ins the night of the event. This measure allows us to have enough of our trained staff on hand to ensure the safe and fun environment our children and parents greatly enjoy. Registration will CLOSE Thursday before the event date! Cost: Members & Non-members : $30 per child
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
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Caregiver
Childcare Center
Childcare Center Director
Father
Grandparent
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Emergency Contact Info (Not Contact #1 or #2)
*
Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities :
Allergies :
Medications :
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities :
Allergies :
Medications :
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities :
Allergies :
Medications :
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities :
Allergies :
Medications :
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Disabilities :
Allergies :
Medications :
Questions/Options:
Are there any allergies that we need to be made aware?
*
For the April 20th Neon Night there is an additional $5 fee for the glow items that will be provided at check in for all who purchase. Would you like to purchase the glow pack?
*
Yes
No
Additional Information:
Water Bottles
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I agree to bring a bottled water for the Parent's Night Out for my child(ren).
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
01
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Exp Year:
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2024
2025
2026
2027
2028
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2030
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2032
2033
2034
2035
2036
2037
2038
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2044
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2046
2047
2048
2049
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2054
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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