Parents' Night Out Child Registration Form
Please fill in the form below.
Name of Child
*
First Name
Last Name
Grade of Child
*
K-1, 2-3, 4-5
Name of Parent/Guardian
*
First Name
Last Name
Parent/Guardian Phone Number
*
Name of Additional Emergency Contact
*
First Name
Last Name
Relation to Child
Phone Number of Additional Emergency Contact
*
Allergies, Medications, Other Medical Alerts or Concerns
*
Pizza (click "Other" if Your Child is Allergic)
Cheese
Pepperoni
Either
Other
Child's Movie Preferences
Tarzan
Toy Story
UP
Lady and the Tramp
Frozen (1 or 2)
No preference
Submit
Should be Empty: