DateNight Raffle Registration
Fill in this form to be entered in a Raffle to win one of two $50 DateNight babysitting Gift Cards!
First Name
Last Name
Email Address
Postal Code
Number of Children
Clear selection
Are you currently expecting?
Clear selection
Age of Child 1
Age of Child 2
Age of Child 3
Age of Child 4
Any Special Needs Concerns
Babysitters you would like to meet
(rates vary based on experience)
When would you like to begin the Babysitter Interview Process?
We will contact you after this date when babysitters in your area become available
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DD
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YYYY
When do you anticipate desiring babysitting services?
If immediately -- choose today's date
MM
/
DD
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YYYY
Submit
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