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LP Girls Night Out April 2025
"
*
" indicates required fields
Child's name
*
First
Last
Email
*
DOB
*
MM slash DD slash YYYY
Age
*
Grade
*
1
2
3
4
5
6
7
8
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
*
Can we text you at this number?
*
Yes
No
Where do you need transportation from?
*
-- Please Choose --
Boro Park
Crown Heights
Five Towns
Flatbush
Jackson
Lakewood
Monsey
Passaic
Queens
Staten Island
Toms River
Williamsburg
Do you have any allergies?
*
Yes
No
What are you allergic to?
*
Are you bringing an Epipen?
*
Yes
No
Do you have any health conditions we should know about?
*
Yes
No
Please specify
*
We love seeing everyone! However, it takes a lot of time and effort to pull this event together. Therefore, if you cancel less than 48 hours prior to the event for any reason other than being sick, we’ll be forced to charge the credit card provided below $50.
*
I understand and accept
Credit Card Number
*
Expiration Date
*
Security Code
*
Billing Zip Code
*
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Refer a Family
Family Name
(Required)
Family City
(Required)
Parent Lost
(Required)
Name of Surviving Parent
Name of Referrer
First
Last
Phone Number of Referrer
Email of Referrer
(Required)
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