Parent's Night Out
Saturday, February 22, 2020
5:00 - 10:00 pm
Evening of fun so parents can have a night out!
Tehachapi Church of the Nazarene
19016 Highline Rd, Tehachapi
Email address *
Parent/Guardian Last Name *
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Parent/Guardian First Name *
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Cell Phone: *
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Emergency Contact Name *
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Emergency Contact Number *
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Child 1 Name *
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Child 1 Age *
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Special Accommodations needed *
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Allergies: *
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Child 2 Name
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Child 2 Age
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Special Accommodations needed:
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Allergies:
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Child 3 Name
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Child 3 Age
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Special Accommodations Needed
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Allergies
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Child 4 Name
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Child 4 Age
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Special Accommodations needed
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Allergies
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Child 5 Name
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Child 5 Age
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Special Accommodations
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Allergies
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Child 6 Name
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Child 6 Age
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Special Accommodations
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Allergies
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