Girls Night Out Registration Form

Participant First Name *

Participant Last Name *

Girl's Night Out Session * (1 required)

Friday, September 9, 2022 Friday, October 14, 2022 Friday, November 11, 2022 Friday, December 9, 2022 Friday, January 13, 2023 Friday, February 10, 2023 Friday, April 14, 2023 Friday, May 12, 2023

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: *