Kidz Night Out - Friday Sept 8 Child's Name (First and Last) Child’s Birthdate(MM/DD/YYYY) If new to Kidz Zone please complete the rest of this form, otherwise just click Submit. Child’s Age Child’s Grade Just Completed (K-5th) If not in school yet, leave blank Parent/Guardian Name (First, Last) Parent Email Parent Cell # Parent Home Phone Street Address City State Zip Medical Concerns (Allergies, etc.) Other Information Additional Adult Authorized to Pick Up Child (other than parent) Contact Phone # Additional Adult Authorized to Pick Up Child (other than parent) Contact Phone # Do you give permission for us to use pictures of your child for social media? Yes No Captcha If you are human, leave this field blank.