ParentsNightOut

PARENTS NIGHT OUT

* Ages 5 - 12

OPMI's Parents Night Out gives YOU an opportunity to take a well-deserved break. Go out for a night on the town feeling confident that your little ones are safe and having the time of their lives.

Activities are based on the month and will always have a THEME!! This month is a Halloween Party!

** Payments are due at the time of registration or your child will not be added to the event. Cancellations must be made by October 22nd in order to receive a refund.

REGISTRATION FORM BELOW

INFORMATION

Drop off Friday night is at Stoneybrook West Towncenter, 1201 Black Lake Blvd., Winter Garden

Hours - 6:00 pm-9:00pm

Cost - $35 for single child

* Siblings are only $20

** Space is limited **

Registration Form

Please note that all fields followed by an asterisk must be filled in.

Parent/Guardian First Name*

Parent/Guardian Last Name*

E-Mail Address*

Street Address*

City*

Cell Phone*

Child's Name*

Age*

Are you signing up siblings?*

	YES
	NO

If you are signing up siblings, how many children in total will participate?

Please list siblings names and ages

PICK SESSION*

Stoneybrook West Towncenter; Friday, October 25, 6-9pm

Additional Authorized Child Pick Up (Please list names, phone numbers, and relation to the child)

Do you authorize OPMI to use photos of your child on our website and/or promotional material?*

OPMI Terms and Conditions*

I understand that this program runs from 6pm - 9pm. Please do not bring your child if they are sick. We will not allow children who are sick to be dropped off; any child who becomes ill during the program will need to be picked up. I understand that pick up is at 9pm; there is a 10 minute grace period, and if I pick up after 9:10pm, I will be charged $5 per minute. Please make sure that your child is in comfortable clothing. I understand there are no refunds for cancellations, leaving early, or not showing up after payment has been made. Any registrations received day prior or day of the event will have a $10 late payment fee applied. Payments are due prior to event. NO PAYMENTS will be accepted in person at the event. If payment has not been made prior to event, then your child may not participate. I have read and agree to the OPMI Terms and Conditions regarding payments and cancellations.

OPMI Payment Policy*

I understand that payment is due at the time of registration or my child(ren) will not be added to the event. I understand the REGISTRATION DEADLINE is 2 days before event, and if I sign up after deadline, late fees will be applied for each child registered. I understand that there are no refunds or credits if I cancel less than 72 hours of the event as supplies and materials are already purchased.

OPMI Liability Waiver*

BY CHECKING THIS BOX, I AGREE THAT I HAVE READ AND VOLUNTARILY SIGNED THIS AGREEMENT ELECTRONICALLY and further agree that no oral representation, statements, or inducement apart from the following written agreement has been made: IN CONSIDERATION of being permitted to utilize the facilities, services and program of ORLANDO PREMIER MUSIC INSTRUCTION, herein after referred to as 'OPMI', for any purpose including but not limited to observation or use of facilities or equipment or participation in any off-site program affiliated with OPMI, the undersigned, for himself or herself and any personal representatives, heirs, children and next of kin, hereby acknowledges, agrees and represents that he or she releases OPMI and its staff members from all liability for an injury, loss or damage connected in any way whatsoever to participation in OPMI activities whether on or off of the premises affiliated with OPMI. He or she understands that this release includes any claims based on negligence.

Special Requests/Needs/Allergies/Concerns:

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