NJHS Parents' Night Out Registration
Please fill out the following form to register your child(ren) for Parents' Night Out. Payment for the evening can be made at the door in the form of cash or check made out to FMS NJHS. Questions? Call Tracy Krysl at (636)358-2098
All proceeds from this event will go toward NJHS service projects and will benefit families in Jefferson County.
Parent Name(s) *
Your answer
Parent Contact Number *
Your answer
Child 1 Name *
Your answer
Child 1 Age *
Child 2 Name
Your answer
Child 2 Age
Child 3 Name
Your answer
Child 3 Age
Child 4 Name
Your answer
Child 4 Age
Special instructions for any children listed above (medical issues, food allergies, etc.) *
Your answer
Emergency Contact Name & Number *
Your answer
*
Required
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