Night Out Registration

Select an Event

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Child Information

Child first name

Child last name

Child date of birth

Parent/Guardian Information

Parent/Guardian name

Phone

Email

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Medical Information and Notes

Optional

Notes

Permissions and Signature

I authorize staff to administer first aid and seek emergency medical care if necessary. * I grant permission for my child to appear in photos/videos taken during the event for promotional and internal use. *

Signature (type full name)

Date

Payment

When you click Pay, you will be redirected to a secure Stripe Checkout page.