EmailMeForm
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Child #1
Check the Parent's Night Out date(s) you would like to register for.
October 20th
1st Child's Name
*
First
Last
Female Or Male
*
Female
Male
Birth Date
*
MM
/
DD
/
YYYY
School Attending
*
Special remarks, allergies, etc.
Will your child be bringing a friend for
"Bring-A-Friend Night"?
Please select
Yes
No
Must be someone who has not attended a Kid's Clubhouse program in the past year.
(Summer Camp, Before & After School, Parent's Night Out, etc...)
What is his/her name?
First
Last
If your child's friend has an additional emergency contact and/or authorized pickup,
please list their name & phone number here.
Do you want to register a 2nd Child?
*
Yes
No
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Total
$0.00
