Parents Night Out Registration & Waiver Registered Event Date(s) Child 1 Name Age Child 2 Name Age Child 3 Name Age Parent/Guardian Name Phone Alternate Phone Home Address City State Zip Code Email Name of Additional Emergency Contact Relationship to Child(ren) Phone Does your child have any allergies or special dietary needs that we should be aware of? Do you authorize any other adult(s) to pick up your child(ren) during the event? Is your child(ren) ccurrently ill, injured, or recovering from an illness/injury? Liability Waiver Participant Release Read Rules I have read and understand the Rules of Play, Liability Waiver, and Payment Requirements for my child(ren) to attend the Parent Night Out Event(s) at Maui Maui Kids Play Island. I attest the information provided on the Registration Form is accurate and true. Late Fees I am aware that there are late fees associated with not picking up my child(ren) before or on time at the end of the Parent Night Out event. I understand I am responsible for paying late fees should I arrive late after 9:30pm. Removal My child(ren) will abide by the rules and instruction/decisions from the Event Leaders. Should there be an issue with appropriate behavior during Parent Night Out (such disruptive or harmful behavior to others or themselves), I understand that my child may be removed from the event and that I may be required to pick my child(ren) up early. Parent/Guardian Signature Date Send
