Youth Council Parents Night Out Registration Form Thank you for helping the Catawba County Youth Council support the United Way! Thank you for registering your child (children) for the Catawba County Youth Council Parent's Night Out program. Children will enjoy a fun night including dinner, games, crafts and movies. Children must be age 4 or older and potty independent Cost for each child is $15.00 If you have any other questions please contact Siobhan Loendorf at 828-465-8292. OK Question Title * 1. What is your child's full name? OK Question Title * 2. What is your child's age? OK Question Title * 3. Does this child have any health or dietary restrictions? OK Question Title * 4. Do you need to register other children? yes no OK Question Title * 5. What is your child's full name? OK Question Title * 6. What is your child's age? OK Question Title * 7. Does this child have any health or dietary restrictions? OK Question Title * 8. Do you need to register other children? yes no OK Question Title * 9. What is your child's full name? OK Question Title * 10. What is your child's age? OK Question Title * 11. Does this child have any health or dietary restrictions? OK Question Title * 12. Please provide contact information. Full name of parent or caregiver Email Address Phone Number OK DONE