Parents' Night Out - YMCA of Greater Houston

A PLACE TO STAY,A PLACE TO GROWParent’s Night OutWEEKLEY FAMILY YMCAEnjoy a night out on the town while the kids enjoy the evening at the YMCA. Children sixweeks to 12 years-old enjoy activities such as arts and craft, sports, games, dancing andmore. Register today at the Welcome Center!Date & Time:Drop off is at 6:30-7pmSaturday, June 216:30-10:30 pmRegistration: NowSaturday, July 196:30-10:30 pmRegistration: NowFeeFacility Members: $15 per childProgram Members: $20 per childSaturday, August 166:30-10:30 pmRegistration: Now*See opposite side for more detailsFor more information, please contact Kendra Carroll atkendra,carroll@ymcahouston.org or 713-664-9622.WEEKLEY FAMILY YMCA7101 Stella Link, Houston TX 77025713-664-9622 | www.ymcahouston.org

My child(ren) will attend:Child’s Name: Age: Sex:Child’s Name: Age: Sex:Parent/Guardian: DL#: ______ Authorized to pick-up: Y NHome phone: _______ Cell phone: _________Parent/Guardian: _ DL# ______ Authorized to pick-up: Y NHome phone: _____ __ Cell phone: _______Home phone: ______ __ Cell phone: ______PARENTS’ NIGHT OUTRules and Regulations - Please Read Carefully• Payment is due at the time of registration. Registration ends at 6pm the night of the event.• Children will be divided by two age groups: 6 weeks– 4yrs and 5yrs-12yrs. No exceptions.Children must be picked up at or before 10:30 pm. A late fee of $3 per minute per child will begin at 10:35 pm. Only cash or check will beaccepted and payment is due upon arrival, no exceptions. Please bring sleeping bags and/or blankets and pillows for movie time. All items must be labeled with the child’s name. Children who are not potty trained must be provided with 6 diapers and baby wipes.• Please provide infants and toddlers with milk and/or formula in plastic bottles, snacks and a change of clothes (outer and inner garments).• Electronics (including cell phones), trading cards, etc are not allowed.• If four or less participants are registered the program will be cancelled for the night. Parents will be notified the Friday before ParentsNight Out.All Parents must present a valid Drivers License when dropping off and picking up.Please adhere to these requests for the safety of your child(ren)Please Read and Sign BelowI hereby certify that my child is in good health and capable of safe participation in this program. I assume all risk and hazardsincidental to the conduct of the program. I hereby authorize the YMCA and its staff to obtain emergency medical treatment for mychild and also authorize medical personnel to treat my child. I understand that the YMCA will make all attempts to contact me andthat I am responsible for all medical bills and charges arising from this medical treatment.Parent’s Signature:Date:medica-*Please list any information about special problems/needs including: allergies, existing illnesses, disabilities, use oftions, etc.Person Picking Up Child: ___________________________________Identification #: _________________