Dance & Move: Parents’ Night Out Registration & Waiver

Dance & Move: Parents’ Night Out Registration & Waiver

Register your child, confirm potty-training and pickup authorization, and review the drop-off agreement, safety policies, and waiver.
Child Information
Child’s Full Name

First NameMiddle NameLast Name
Child’s Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child’s Age
Parent/Guardian Full Name

First NameMiddle NameLast Name
Parent/Guardian Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Allergies
Medical Conditions, Medications, or Other Information Staff Should Know
Eligibility, Potty-Training, Drop-Off, Behavior, and Safety Acknowledgments
Eligibility and Potty-Training Acknowledgment
Drop-Off, Behavior, and Safety Acknowledgment
Cancellation Policy, Payment, and Final Agreement
Cancellation Policy

Registration is nonrefundable because enrollment is limited to 6 children. Registration may be transferred to another eligible child with advance notice to Grace & Grow Play.

Dance & Move Parents’ Night Out registration fee

$30.00

Total

Credit Card

Apple Pay