Registration

Enjoy the night out while we entertain the Kids. Open Gym time, Snacks, Movie, and Games
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:
 
Assumption of Risk
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I've read the above and agree.
 
Release OF Liabiltiy
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I've read the above and agree.
 
Parental Consent
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments: