MHCC's Parent's Night Out
Christmas Shopping Edition!
Register up to 3 kids per form. Ages 4-11; PreK-5th grade. Pay the day of event. $5/child. Cash only.
Event Date: Saturday 12/9/17 4:00-8:00pm
Email address *
Parent/Guardian Name: *
Your answer
Phone: *
Your answer
Emergency Contact Name & phone #, other than yourself *
Your answer
Emergency Release-Check box below *
Captionless Image
Required
Student #1's Last Name *
Your answer
Student #1's First Name
Your answer
Insurance Carrier and id#
Your answer
Student #1 Allergies? *
Your answer
Student #1 Grade *
Student #2's Last Name
Your answer
Student #2's First Name
Your answer
Insurance Carrier and id#
Your answer
Student #2 Allergies?
Your answer
Student #2 Grade
Student #3's Last Name
Your answer
Student #3's First Name
Your answer
Insurance Carrier and id#
Your answer
Student #3 Allergies?
Your answer
Student #3 Grade
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