Kids Night Out at The Learning Center

Kids' Night Out is an opportunity for parents to get away for a couple of hours with peace of mind knowing their children are engaged in a safe, engaging and fun environment filled with group games, recreation & sports.

Dates: Saturdays | 6:00 pm - 9:00 pm

Sept 18, 2021

Kids' Night Out

$27.00

Kids' Night Out - Siblings

$13.00

The Symbolic Art Learning Center, 2021
Please note that all fields followed by an asterisk must be filled in

* Indicates required field

Section #1 ~ Child's Information

Name of Child Enrolled *

First

Last

DATE OF BIRTH *

Name of School *

"ANY" SPECIAL NEEDS STAFF NEED TO BE AWARE OF? (N/A) IF NOT APPLICABLE *

Any allergies? N/A if not applicable *

Section #2 ~ Sibling's Info

Insert The Name(s) of Sibling(s) "N/A" if Not Applicable *

Sibling(s) Date of Birth *

Sibling(s) Allergies or Special Needs? N/A if not applicable *

Insert the name of the Last Symbolic Art Program Enrolled *

How Did You Hear About Symbolic Art Learning Center? *

Kids' Night Out Dates *

Sep 18th

Section #3
Enrolling Parent/Guardian Info

Parent or Guardian's Name *

First

Last

Parent or Guardian's Email *

Alternate Email *

Alt Phone# *

Insert The Name & Phone Number To Receive Text Messages *

Insert Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Section #4
Emergency Contact Info

1st Emergency Contact's Name N/A if Not Applicable *

First

Last

Phone# N/A if Not Applicable *

2nd Emergency Contact's Name N/A if not applicable *

First

Last

Phone# N/A if Not Applicable *

Insert Name(s) of anyone other than parent, guardian or emergency contact who may pick up Child(ren) *

Symbolic Art Learning Center
2402 N. Tenaya Way
Las Vegas, NV 89128
Hours: 6:00 pm - 9:00 pm
SymbolicArtCenter@gmail.com

Symbolic Art Kids' Night Out:

An evening meal is included i.e. pizza, drink & chips

Fee Disclosure*

An 'annual' registration fee: $25 is required for each new participant not currently enrolled in other Symbolic Art programs; Symbolic Art Learning Center rates: *$27 1st Child & $13 Siblings *Enrollment fees are non-refundable in the case a participant is absent from the program. Payments may be made in cash, money order or credit card. Payments will only be accepted from adults listed on this form. A $10 late fee will be assessed for each :15 minutes past 6:00 p.m. (e.g. 6:05 pm / pick up = $10)

Agree & Consent *

I understand the above and consent

Sign-In & Sign-Out

To protect the safety of our children I understand each child must:

Not enter the learning facility with a cough that cannot be attributed to another health condition
Not enter the learning facility with a condition of shortness of breath that cannot be attributed to another health condition
Not enter the learning facility with any two of the following symptoms: Fever (100.4 F or higher), chills, repeated shaking with chills, muscle pain, headache, sore throat or new loss of taste or smell
Not enter the learning facility if the child had come into close contact (within 6 feet) with someone who has a laboratory confirmed COVID-19 diagnosis in the past 14 days
Participants will be escorted to and from the learning facility by Symbolic Art Staff. Parents/Guardians/Visitors will not be permitted inside the learning facility.
The only person(s) authorized to pick up the child(ren) are those listed on this form; photo ID must be shown.

Agree & Consent *

I understand the above and consent

Children "will not" be released without proper identification "and" prior written authorization from enrolling parent/guardian. *Authorization via Email is acceptable

AGREE & CONSENT *

I understand the above and consent

In the case of joint custody disputes - Symbolic Art staff will comply "Only" with "Written" instructions directed by court order on file with Symbolic Art (if applicable)

AGREE & CONSENT *

I Understand the above and consent

Waiver of Claim*

For ourselves, and/or on behalf of our child named above, our heirs, executors, and administrators, we hereby do expressly and forever waive and hold harmless Symbolic Art Central, Inc dba Symbolic Art and their respective officers, employees, agents or representatives from any and all liability for personal injury or damages, sustained, incurred, arising from and/or connected with travel to, return from any and all classes, activities, tournaments and/or special events, and all activities related to, or in connection with said activity by ourselves or by our child. *Symbolic Art is a community based organization focused on making sports, recreation and artistic expression fun for youth ages 5-12.During programs or events sponsored Symbolic Art staff may take photos of participants that may be used in professionally designed publications, Symbolic Art websites, social media platforms and other promotional materials.

AGREE & CONSENT *

I understand the above and consent

Parent Letter*

I have received, read and understand the contents of the parent letter

AGREE & CONSENT *

I understand the above and consent

Please Type Your Name to Acknowledge An Acceptance of Symbolic Art Terms & Conditions

Name *

First

Last

Submit Registration Form

Kids' Night Out

Kids' Night Out - Siblings

The Symbolic Art Learning Center, 2021Please note that all fields followed by an asterisk must be filled in

Section #1 ~ Child's Information

Section #2 ~ Sibling's Info

Section #3Enrolling Parent/Guardian Info

Section #4Emergency Contact Info

Fee Disclosure*

Sign-In & Sign-Out

Waiver of Claim*

Parent Letter*

Please Type Your Name to Acknowledge An Acceptance of Symbolic Art Terms & Conditions

The Symbolic Art Learning Center, 2021
Please note that all fields followed by an asterisk must be filled in

Section #3
Enrolling Parent/Guardian Info

Section #4
Emergency Contact Info