Be My Valentine!

Parents Night Out for Ages 5 and Up!

Roses are Red, Violets are Blue, time for you to enjoy a dinner for two

Take the night off and spend your valentines with that special someone! Drop the kids off for a fun night of cheerleading, craft, pizza and more!

💰 Pricing:
➡️ $49.99 for Child 1
➡️ $40.00 for Child 2
➡️ $38.00 for Child 3
(All prices + HST)

Parent/Guardian Name *

First

Last

Email *

Your account will be created using this email address

Phone Number *

Home Address *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Child's Name (1) *

First

Last

Child's Date of Birth (1) *

Allergies or medical conditions? If so, what are they? (1) *

Medicare # and expiry date (1) *

Child's Name (2)

First

Last

Child's Date of Birth (2)

Allergies or medical conditions? If so, what are they? (2)

Medicare # and expiry date (2)

Child's Name (3)

First

Last

Child's Date of Birth (3)

Allergies or medical conditions? If so, what are they? (3)

Medicare # and expiry date (3)

I would like to pay via: *

• Etransfer
• Credit or debit

Once total amount received, registration is finalized. Etransfers can be sent to info@506eliteallstars.com password "506elite". For credit payments, we will email you to set up a call for payment! We will email you a confirmation at the address provided!

Event date(s) or name(s) registering for: *

Submit