Parent Night Out Registration Form
Please complete one form per parent night, per family.
Email address *
Date *
Child #1 *
Your answer
Child #2
Your answer
Child #3
Your answer
Child #4
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Emergency Contact Name and Phone Number *
Your answer
Please list any allergies, special concerns, etc. that you would want the staff and volunteers to know about your child. *
Your answer
PRYC LIABILITY STATEMENT: The PRYC refund policy is firm. Only unusual circumstances warrant a partial credit or refund. After the PRYC has held the first class, no refunds or credits are given. Membership fees are non-refundable. Registrants will receive full credit for programs cancelled by the PRYC. In consideration of allowing the named participant to enroll in an activity or program upon the premises at PRYC or an off premises activity or program sponsored by the PRYC, I/we assume all risks and hazards incidental to such participation including transportation to and from the activity or program. We hereby waive, release, absolve, indemnity, and agree to hold harmless the PRYC, the organizers, all officers, directors, sponsors, supervisors, participants, volunteers, employees, agents and instructors any claim arising out of an injury or accident. NOTE: I AUTHORIZE PRYC TO TAKE AND USE PHOTOGRAPHS DURING ACTIVITIES WHICH WILL ONLY BE USED FOR PROMOTION OF THE CENTER’S PROGRAMS. I hereby declare any physical problems or restrictions and declare the participant to be in good physical and mental health. I also list any additional information that would help the PRYC staff in working with my child or me. I have read, understood, and agreed to all of the above information here in his form. *
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