Aloha

Kids' Night Out for...

Child's Name (and nickname, if any):

Date of Birth (we accept ages 3-10):

Child's Gender
Boy Girl
Parent(s)/Guardian(s) Name(s):

Mailing Address:

Your Email:

Home Phone:

Cell Phone:

Other Phone (please specify):

Does your child have allergies? If so, please explain:

Other information we should know: