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LEAP Math and Reading

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Parents’ Night Out

(2nd and 4th Fridays)

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Name

First

Last

Email

Phone

Kid's Allergies

Date kid(s) Release

Names of kid(s) and age(s)

Date of Attendance

Liability Waiver

I hereby certify that my child(ren) is/are in good physical condition. I acknowledge that LEAP will not assume any responsibility or liability for personal injury or damages caused by the injury. In the event LEAP is unable to reach a parent, guardian or emergency contact, I hereby give permission for my child(ren) to be transported to the nearest hospital for treatment. I further authorize any of the the staff to provide for, approve and authorize health care at hospital.

Photo/Media Release

I hereby grant and authorize LEAP the right to take, edit, copy, publish, distribute and make use of any and all pictures or video taken of my child(ren) to be used in and/or for legally promotional materials and digital communications. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of and will not be returned.

PayPal Commerce

Card Number

Expiration Date

Security Code

Card Holder Name

Parents’ Night Out

One kid – $50
Two kids – $90
Three kids – $130
LEAP Family – 50% off all pricing
Kids must be potty trained (3 years old and up)

Cancellation/Refund

Parents’ Night Outs are non-refundable
For cancellations received by 5pm one day prior, we are able to apply credits to a future date night up to three months from the originally booked date night.

Food

We provide food and dessert for dinner
We are unfortunately not able to accommodate other special food requests. If your child has specific dietary restrictions, we ask that you please send a prepared meal with your child.