PARENTS NIGHT OUT - NOVEMBER 13TH, 2026

CHILD #1 FIRST & LAST NAME

AGE

Is the participant allergic to anything? Please answer yes or no. If yes, list the allergy*

CHILD #2 FIRST & LAST NAME

AGE

Is the participant allergic to anything? Please answer yes or no. If yes, list the allergy*

CHILD #3 FIRST & LAST NAME

AGE

Is the participant allergic to anything? Please answer yes or no. If yes, list the allergy*

CHILD #4 FIRST & LAST NAME

AGE

Is the participant allergic to anything? Please answer yes or no. If yes, list the allergy*

Are there any special needs or medical information we should know about any of your children so that we can comfort them? If yes, please provide a brief description and child's name. *

PARENTS/CAREGIVER FIRST & LAST NAME

This address will receive a confirmation email

CELL/TEXT #

ADDRESS

Emergency Contact Name and Cell Phone Number *

Can the participant be photographed? Images will be used for presentations. *

YES NO

How did you learn of this event? *

** A liability and consent form will be emailed to the address provided on NOVEMBER 9TH, 2026. It must be printed, signed and provided at drop off on the day of the event in order for your child(ren) to participate. Thank you!

I agree to the following: *

Event staff will call 911 in the case of an emergency and notify caregiver/emergency contact.ption Event staff will provide basic first aid in case of a non-emergency injury and notify caregiver/emergency contact. Students must be escorted to and from the front desk and signed in and out To print and complete the consent and liability form as mentioned in paragraph above.

First child -$10, Second child - $5, Third child - $5, Fourth child - $5 Please provide total for your family's registration and click payment button

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Friday, November 13th 5:00PM - 8:30PM

Enjoy your night out knowing your kiddos will be safe having fun @Marshmallow Madness with friends, playing games, being fed pizza & with fresh veggies, reading or listening to stories, and doing a "Give Back" project for the community.

Registration Deadline: November 8th.
Please complete the form and submit.

PARENTS NIGHT OUT - NOVEMBER 13TH, 2026

Description

Please Fix the Following