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Parent’s Night Out – March 28

Fundraiser for the Company Team Booster Club

Enjoy a night out on the town while the kids enjoy the evening at the studio.
Children will enjoy such activities as arts and crafts, dancing and more!

Friday March 28, 2014
7:00PM to 10:00PM
Ages 3 and up (potty trained)
Cost is $20 per child and $15 for each additional sibling.

Space is limited to the firsƚ 30 that sign up and pay.

My Child(ren) will attend:

Child’s name:________________________________________ Age & Sex: ______________________

Child’s name:________________________________________ Age & Sex: ______________________

Child’s name:________________________________________ Age & Sex: ______________________

Parent/Guardian:_______________________________________________________________________

Contact Phone number: ______________________________________________________________

Payment is due with completed registration only cash or checks (to booster club) are accepted.

Children must be picked up no later than 10:10PM

Please label all items your child may bring i.e. blanket etc. we encourage you to be careful if bring electronics as we cannot be responsible for them.

All Parents must present a valid ID when dropping off and picking up.  Please adhere to these request for the safety of your child(ren).

Please read and Sign Below

I hereby certify that my child is in good health and capable of safe participation in the program.  I assume all risk and hazards incidental to the conduct of the program.  I hereby authorize Steppin’ Time and the booster club staff to obtain emergency medical treatment for my child and also authorize medical personnel to treat my child.  I understand that the staff will make all attempts to contact me and that I am responsible for all medical bills and charges arising from this medical treatment.

Parent’s Signature:

_________________________________________________Date:_________________________

 

Please list any information about special problems:

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