Date Night Drop in Registration

Attention Parents! Yes YOU! We know how hard you've been working and you deserve a break! Whether you are a single parent, married parent, grandparent, guardian or someone who is helping to raise another human being, we'd like to help you while also helping our neighborhood, The Paseo Arts District!

From 6-9:30pm on the third Thursday of each month (October through April) we'd like to help give you a break. 20 kids (first come, first served), ages 3-12, are welcome to be dropped off at SixTwelve for childcare. We'll provide snacks, art projects, music story time, games and lots of other fun activities. (If you have a student 12-17 years old who would like to help with childcare, we'll work out an assistant's discount or credit!)

The cost is $10/hour/kid, but if you bring back a receipt from one of our neighborhood restaurants, Picasso CafePaseo Grill, or Sauced or from one of the wonderful galleries in the district, at the end of your "date" we'll take 20% off the cost of your child care! You must visit these Paseo Arts District establishments the same night as the Date Night Drop In for this offer to be valid.

Please fill out this form in order to register your child for Date Night Drop Off. We will have a policy agreement for you to sign and a copy for you to take with you when you drop off your child.

Student Name *
Student Name
Student's Birthdate *
Student's Birthdate
Primary Parent/Guardian Name *
Primary Parent/Guardian Name
Primary Guardian Phone *
Primary Guardian Phone
Student/Primary Guardian Address *
Student/Primary Guardian Address
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
In the event that there is an emergency with your child and we can not reach you, or if your child's life/welfare depends upon an immediate need to call 911, do we have permission to call 911?
Electronic Signature *
Electronic Signature
By adding your name in the following fields, you authorize SixTwelve to care for your child/student during Date Night Drop In events and agree to abide by all policies/procedures set forth by SixTwelve. A copy of all policies will be given to parents when they drop off their child/student for each event. Parent/Guardian understands that if there is a behavioral issue with their child/student, SixTwelve will call/contact parent/guardian and they must pick up their child/student as quickly as possible.
Today's Date *
Today's Date