Pinnacle Homes Sponsored Parents Night Out

WATERLEIGH COMMUNITY CENTER: FRIDAY, FEB 12th, 6-9PM

STONEYBROOK WEST TOWN CENTER: SUNDAY FEB 14th, 6-9PM

INFO

Drop off Friday night is at Waterleigh Phase 2 Club House -16150 Pebble Bluff Loop, Winter Garden

Drop off Sunday night is at Stoneybrook Town Center - 1201 Black Lake Blvd., Winter Garden (Need ID for gate access if not a community member)

Hours - 6:00pm-9:00pm

**Space is limited**

***Social Distancing will be implemented and Masks are required (Temp checks upon arrival)

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*

Would you like to receive information in the future regarding other events, after-school classes, summer camps, promotions?

	YES
	NO

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*

Waterleigh Community Center Friday, Feb 12th

Do you authorize other adults to pick up your child?*

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 and that my child will be fed dinner and will get to work on a project to take home. Please do not bring your child if they are sick. We will not allow children that are sick to be dropped off; any child that becomes ill during the program will need to be picked up as well. 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 have read and agree to the OPMI Terms and Conditions regarding payments and cancellations.

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 negligenc

Special Requests/Needs/Allergies/Concerns:

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Pinnacle Homes Sponsored Parents Night Out

Registration Form

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