PARENT’S NIGHT OUT PTA Fundraiser registration form

1. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PARENT’S NIGHT OUT PTA Fundraiser registration form Registration Instructions Please fill out entire form. Place $ and registration form in an envelope labeled: PARENT’S NIGHT OUT. Send to Main Office by Wed. Nov. 27, 2013. Someone will confirm your child/children’s spot via email. Checks made payable to HES PTA The PTA thanks you for participating in this FUNdraiser. Child’s name & age* ____________________________________ ____________________________________ ____________________________________ ____________________________________ Contact person’s name & phone (2 please) ____________________________________ ____________________________________ Email address ____________________________________ Allergies/Special needs _______________________________________________ _______________________________________________ _______________________________________________ Liability Waiver I, the undersigned parent/guardian of _________________________ do hereby consent to his/her participation in this Parent’s Night Out** Sign (print)_______________________________ Signature_________________________________ *Children must be potty trained **I grant Parent’s Night Out staff the authority to obtain emergency medical treatment as necessary for my child, and in no way hold them responsible in the event of accidental injury. Hatfieldmapta.digitalpta.com Facebook.com/hatfieldelementaryschool Squareup.com/market/hatfield-elementary-pta