1. FOR YOUTH DEVELOPMENT
FOR HEALTHY LIVING
FOR SOCIAL RESPONSIBILITY
Kids Night Out
Saturday, Jan. 26th 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. South County Family YMCA - 12736 Southfork Rd., St.
Louis Mo 63128
Please make checks payable to the
South County Family YMCA Jennifer Davis, Program Director
jdavis@ymcastlouis.org or 314.849.4668 ex. 235
Kids Night Out Sat. Jan. 26, 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