Parent's Night Out
Saturday, March 11th (5-9pm)
745 Cinema Court, Kernersville, NC 27284
**Must be kindergarten-8th grade**
$25/1 child, $40/2 children, $50/3 children, $55/4 children (CASH only please…pay at drop off)
Pizza, drinks, treats, and lots of activities with plenty of adult supervision will be provided!!
Must RSVP by Friday, March 10th.
Please email Jill.eversole@gmail.com with any questions or cancellations.

**Please send your child with a refillable water bottle!

Name of 1st Child: *
Age of 1st Child: *
Name of 2nd Child:
Age of 2nd Child:
Name of 3rd Child:
Age of 3rd Child:
Name of 4th Child:
Age of 4th Child:
Allergies/Medical Concerns:
I give permission for my child/children to attend The Kids’ Clubhouse Program. My child may also participate in the activities provided by the program. I surrender my rights to litigation, civil or criminal, to any volunteer or employee of The Kids’ Clubhouse for injuries, whether physical or emotional, which may occur during normal activities, as the law does allow. *
Required
Parent/Guardian Name: *
Parent/Guardian Email: *
Parent/Guardian Phone Number: *
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