Girls Night Out Registration Form

Participant First Name *

Participant Last Name *

Girl's Night Out Session * (1 required)

Friday, December 13, 2024 Friday, January 10, 2025 Friday, February 14, 2025 Friday, April 11, 2025 Friday, May 9, 2025

Date of Birth *

Age *

Grade *

School Currently Attending *

Participant Address *

Address 1
Address 2

City

State

Zip

Parent/Guardian 1 Name *

Parent/Guardian 1 Email *

Parent/Guardian 1 Phone *

Parent/Guardian 1 Relationship * (1 required)

Mother Father Grandparent Aunt Uncle Other

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Parent/Guardian 2 Relationship

Mother Father Grandparent Aunt Uncle Other

Emergency Contact 1 Name & Relationship *

Emergency Contact 1 Phone *

Emergency Contact 2 Name & Relationship

Emergency Contact 2 Phone

Does the participant have any food allergies, medical or special needs? * (1 required)

Yes No

If yes, please list:

Photo Release

I understand that my child may be photographed, and featured in SPSCC publications and social media.

Enter Your Email Address: *