Creekside's Parent's Night Out
Sign up here to reserve your spot for Parent's Night Out!

(You may use one form to sign up for multiple nights, or fill out separately per event.)

Dates:
Wednesdays 5:30-8:30
- June 27
- July 11
- July 25
- August 8
- August 22

Cost:
- Members: $15 per child per event
- Non-Members: $20 per child per event

You may pay ahead via:
- PayPal: paypal.me/SwimCreekside
- Venmo: @Swim-Creekside

Children must be 3 or older and must be potty trained.

Open to members and non-members.

Parent's Name(s) *
Your answer
Parent's Phone Number (in case of emergency) *
Your answer
Choose which date(s) you want to have your child(ren) attend Parent's Night Out *
Required
CHILD #1
Child #1: Name *
Your answer
Child #1: Age *
Your answer
Child #1: Swimming Level *
Child #1: Medical or Dietary Concerns We Should Know About *
Your answer
CHILD #2
Child #2: Name
Your answer
Child #2: Age
Your answer
Child #2: Swimming Level
Child #2: Medical or Dietary Concerns We Should Know About
Your answer
CHILD # 3
Child #3: Name
Your answer
Child #3: Age
Your answer
Child #3: Swimming Level
Child #3: Medical or Dietary Concerns We Should Know About
Your answer
CHILD #4
Child #4: Name
Your answer
Child #4: Age
Your answer
Child #4: Swimming Level
Child #4: Medical or Dietary Concerns We Should Know About
Your answer
CHILD #5
Child #5: Name
Your answer
Child #5: Age
Your answer
Child #5: Swimming Level
Child #5: Medical or Dietary Concerns We Should Know About
Your answer
Release
Please sign this release by entering your first and last name in the space below: I, the undersigned and parent/guardian of the children listed above, am voluntarily leaving my child(ren) with Creekside and its Parent's Night Out program, and hereby release and waive against all claims Creekside, its agents, employees, volunteers, representatives, officers, and directors from any injuries or damages occurring while the above child(ren) is/are in their care. I also grant my authorization and consent for a designated adult to administer general first aid treatment for minor injuries or illnesses. If the injury or illness is severe, I authorize him or her to seek professional emergency personnel to attend, transport, and treat the minor and to issue consent for any medical care deemed advisable by a licensed medical professional or institution. I authorize the designated adult to exercise best judgment upon the advice of medical or emergency personnel. *
Your answer
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