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Join us for a special evening at our "My Guy and Me" Valentine Dance. Dads, grandpas, uncles, brothers, and friends all welcome! The evening will include photo ops, dancing, games, crafts, and hors d'oeurves. The event is 4-7 PM, with bingo and prizes at 5:30. Cost is $60 per couple. Additional guests are $30 each.

Event:

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Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info*

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: *
	Student Gender: *	Birth Date: * (format=mm/dd/yyyy)
	Student Email:
	School:*	23-24 Grade Level:*
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):

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Please list the names of attendees. $60 cost includes 1 child and 1 adult. Any additional guests are $30 each.*

Additional Information:

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