Parent's Night Out RSVP 家長約會之夜 必需報名
Event Address: 65-15 164th St. Fresh Meadow, NY 11365
Contact us at (718) 463-8462 or Email frankh@qhc.org
Date: 1/25/19
Time: 6:30 pm - 9:30 pm
Age 年齡: 5 -12
Fee: Free 免費 (Free will donation 自由奉獻)
One Form Per Child 每個孩子一個表格
Email address *
Child's Name 孩子的名字 *
Your answer
Child's Age 孩子的年齡 *
Your answer
Parent‘s Name 父母的名字 *
Your answer
Cell Phone 電話 *
Your answer
Address 地址 *
Your answer
Email 電子郵件
Your answer
Will join dinner at 6:30? 會在6:30 參加晚餐嗎? *
Child's Allergy 孩子的過敏 *
Your answer
How did you hear about this event? 你是怎麼聽說這個節目的? *
As a parent/ guardian of a participant in this program, i recognize and acknowledge that there are certain risks of physical injury and i agree to assume the full risk of any injuries, damages or loss which i or my ward my sustain as a result of participating in any and all activities connected, or in any way associated with the activities of this program. 作為家長/監護人,本人明確知道這項活動會有身體損傷的風險,本人願意承擔在參與這項活動中或任何與是項活動有關相連的活動中可能發生的所有風險、損傷、毀壞或損失。 *
Parent Signature 家長簽名 *
Your answer
A copy of your responses will be emailed to the address you provided.
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