Parent's Night Out - Elementary

Use this form to sign up for your elementary age child, ages 5 to 12 years. Please fill out one form per child. A link will be sent once you submit this form to sign up additional children.

If you have more than one child attending, you may want to contact us first to be sure we still have enough room. There are 8 slots for nursery and 8 slots for elementary (5 - 12 yrs) and the forms will automatically be disabled when those numbers are reached. Please call or text 682-338-4485. (text is better if it is after business hours)

Parent/Guardian Name

This address will receive a confirmation email

Phone

An intake form is required for each participant. A link to that form will be emailed to you upon submission, if you have not already filled one out. Or click here to go to that form.

I have filled out the intake form for my child

Child's Name

Emergency Contact

We would like to stress the importance of safety and communication with you as we care for your child. We need to be able to get in touch with you in any situation that may arise. We will use the emergency contacts from your intake form. If you have any additional contacts for emergencies, please tell us here.

Emergency Contact Name

Phone

Pick Up

Pick up time is between 8 - 8:30 pm. We appreciate your timeliness in picking up your child.

Please indicate that you have read and understand our pick up policy

I understand that general pick up time is 8 - 8:30 pm I understand that if I am to pick up earlier or later than the appointed pick up time, I must communicated with the nursery staff I understand that late pick ups will be noted and could affect future participation in these events If someone other than a parent or guardian is to pick up, parent permission and guardian ID is required

Who will be picking up your child?

If you will not be picking up your child, we need the full name, address and phone number of the person picking up. They will be required to show their ID before your child is released to their care.

The fee for Paren't Night Out is $20. You may pay in cash when you drop off your child, or you can pay by card here. If you have more than one child, please wait until you have filled out a form for each child, and then submit the total.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Parent's Night Out - Elementary

Description

Please Fix the Following