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Parents Night Out Info/Pay Form

Please enter information separately for each child attending. There are 3 sets of boxes to accommodate single child attendees and up to two additional siblings. If no siblings will be participating, please leave these boxes blank.

Contact Email

Child's Name

Age & DOB (Must be at least 3 and potty trained)

Sex

Allergies or Special Needs

Anything we might need to know about your child:

Do you give permission for your child to:

Have their face painted

Have their nails painted

Watch a G-Rated Movie

Sibling 1 Name

Age & DOB (Must be at least 3 and potty trained)

Sex

Allergies or Special Needs

Anything we might need to know about your child:

Do you give permission for your child to:

Have their face painted

Have their nails painted

Watch a G-Rated Movie

Sibling 2 Name

Age & DOB (Must be at least 3 and potty trained)

Sex

Allergies or Special Needs

Anything we might need to know about your child:

Do you give permission for your child to:

Have their face painted

Have their nails painted

Watch a G-Rated Movie

EMERGENCY CONTACT DETAILS:

Parent 1 Name

Parent 1 Phone

Parent 2 Name

Parent 2 Phone

Emergency Contact Name

Emergency Contact Phone

Select an item ($)

Participant - $36

Participant + 1 Sibling - $56

Participant + 2 Siblings - $76

Thanks for submitting!
We’ll contact this person only in case of emergency.

We've reached our participant limit.

CONTACT

For general questions,

contact our Business Manager.

EXPERIENCE

Parents Night Out Info/Pay Form

Please enter information separately for each child attending. There are 3 sets of boxes to accommodate single child attendees and up to two additional siblings. If no siblings will be participating, please leave these boxes blank.

EMERGENCY CONTACT DETAILS:

CONTACT

EXPERIENCE

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