Parent's Night Out Registration

Child Information

Playtime Indoor Play Place LLC
270 Capistrano Road, Ste 6
Half Moon Bay, CA 94019
Saturday, Decembre 7, 2019
Enjoy an evening out while we keep your little one busy with supervised play, story time & more. Cheese pizza dinner, cheese cracker snack, and organic juice is included. This special event is open to children 1 to 5 years old. Older children are welcome if accompanying a younger sibling.
Parents to provide diapers, a change of clothes, and a water bottle. Please label water bottles and diaper bags with child's name.
If think will be your child's 1st visit to Playtime, please complete our Online Waiver.
Must register in advance. Space is limited. Non-refundable.
Subject to cancellation due to low enrollment.
Is your child in diapers or potty trained? *
Is your child in diapers or potty trained?
Is your child in diapers or potty trained?

Parent/Guardian Primary Contact

Relationship to Participant: *
By signing below, I agree to Waive and Release of any and all liability from Playtime Indoor Play Place in the administration and use of the Epi-Pen and hereby give my permission for the Playtime staff to change my child’s diaper during the time that my child is in their care. I agree to forever release and discharge Playtime Indoor Play Place and its directors, officers, employees and volunteers from any and all liability, claims, actions, rights of actions, damages, and expenses, including attorney expenses. In the event that my child needs immediate attention for injuries received while participating in a Playtime Indoor Play Place program, I authorized Playtime Indoor Play Place staff to give my child reasonable first aid, and to transport my child to a health care facility for emergency services as needed. I hereby acknowledge that the Playtime Indoor Play Place will assume that either parent of the child may pick up the child at any time during the program unless there is pertinent court documentation on file at Playtime Indoor Play Place that indicates otherwise. I hereby release all pictures of my child taken by Playtime Indoor Play Place for promotional purposes and programming materials including the Playtime Indoor Play Place website and social media. *
I authorize Playtime! HMB to charge my credit card for the below listed amount. *