Parents Night Out Registration

Cost Per Child: $35 Prior/Current Student $25 - Feel free to reach out to Dirt Learning with any questions.

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

I understand *

there is only so many available spots for this night. If I am unable to attend the cost is non-refundable as this payment reserves your childs spot in the class.

What day are services to be rendered? *

You may select both days if needing services rendered for both Parent Night Out events.

How many kids will be in Child Care *

Cost: $35 per child per event night or $25 for current or prior students

Cost for Event day(s) *

Please total all cost.

Child(s) Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )

Total Cost being paid online for daycare

Only enter amount if paying through square at time of submission.

Square *

Card

Name on Card