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Parents Night Out Registration Form
March 16 | 5-10 PM
Questions? Contact 316-799-2471
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* Indicates required question
Child's Name (please fill out one form per child)
*
Your answer
Child's Age
*
Your answer
Parent's Name
*
Your answer
Parent's Phone Number
*
Your answer
Food Allergies?
*
Yes
No
If answered "yes" to question above, please describe.
Your answer
We plan to drop our child off between
*
5-6 PM
6-7 PM
7-8 PM
We plan to pick up our child between
*
6-7 PM
7-8 PM
8-9 PM
9-10 PM
I give permission for my child to participate in Parents Night Out. I will assume all responsibility for my child in case of an accident or injury. (please sign full name)
*
Your answer
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