FOR YOUTH DEVELOPMENT

FOR HEALTHY LIVING

FOR SOCIAL RESPONSIBILITY

Kids Night Out

Saturday, May 4th 2013

7pm-10pm $12/child

50% of Pre-registered tickets benefit:

Sperreng and Truman Middle School

What to expect:

Swimming, Games, Basketball, Volley-

ball, Dancing, Dodgeball, Movies and

much more.

Concession available.

Please make checks payable to the

South County Family YMCA

South County Family YMCA - 12736 Southfork Rd., St.

Louis Mo 63128

Jennifer Davis, Program Director

jdavis@ymcastlouis.org or 314.849.4668 ex. 235

Kids Night Out Sat. May 4th 2013

Please complete the following registration information and return to school office.

Child’s Name ____________________________________ Date of Birth_________________________

Child’s Name ____________________________________ Date of Birth_________________________

Child’s Name ____________________________________ Date of Birth_________________________

Address _____________________________________________________________________________________

Parent/Guardian Name _________________________________________________________________________

Home Phone # __________________________________________________Cell Phone # ____________________________________

Parent Email Address____________________________________________________________________________________________

To be filled out by parent: ____ YES, my child is allowed to swim ____ NO, my child is not allowed to swim

Parent Signature ______________________________________________________________________________

For more information contact Jennifer Davis at 314-849-9622 ext. 235