Lighthouse Youth Spring All-Nighter

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Lighthouse Youth Spring All-Nighter

7691 Bridgeport Kirkville Rd

Kirkville NY 13082

Time: 7 PM-8 AM

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Students Name? (If a family put all names of students attending.) *

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Students Age & Grade *

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Student's Address? *

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Allergies/ Important Info? *

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Parent/Guardian (First and Last Name) *

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Parent/Guardian Phone Number *

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Parent/Guardian Email Address *

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Emergency Contact (Name and Number) *

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Pick-Up Permission (List of people allowed to pick up the student(s)) *

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