Kid's Night Out Registration
Leave the kids with us from 5-7:30pm for a fun-filled evening while you take a well deserved break to shop, relax, dine out, wrap gifts...whatever! The Dixon PTO board and Dixon High School Cheerleaders have you covered. Please turn in a check for $15 for the first child and $10 per additional child in the same household made out to the Dixon PTO to the school office no later than December 8th. No children in diapers please.
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メールアドレス *
A Parent/or guardian MUST come into Jefferson school to sign your child(ren) in/out

 *
Your Name *
Your Child(rens) name and age *
Phone Number *
Allergies or food restrictions we should know about.
Pizza preferance
Cheese
Sausage
Pepperoni
Child 1
Child 2
Child 3
Child 4
Child 5
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Who will be picking up your child(ren)? *
I hereby allow my child/children to participate in the PTO Kid's Night Out and assume all risks and in consideration of his/her participation in said program do hereby waive and release all claims arising as the result of personal injuries or property loss because of the program. I furthermore authorize the staff in the event of illness or injury to administer emergency care and arrange for medical transportation to the nearest hospital deemed appropriate. I understand every effort will be made to contact the parent/guardian prior to any involved treatment. I grant permission to qualified physicians/ or other medical personnel to furnish medical care using the above guidelines while my child/children attend the PTO Kid's Night Out. I also agree that my insurance carrier or I will bear the financial responsibility for any medical treatment administered under the above guidelines.  
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