Parents' Night Out

Friday, November 20, 2026 · 6:00 PM to 10:00 PM · Junior Academy, 1311 N. Nevada Ave., Colorado Springs

Open to the PublicAll Families Welcome

Enjoy a night out while your child has fun with crafts, games, and a movie with our licensed staff.

Enjoy a Night Out, We've Got the Kids!

Drop the kids off for an evening of games, crafts, a movie, and food and drinks with our state licensed staff, while you enjoy a dinner, a movie, or some holiday shopping.

Friday, November 20, 2026 · 6:00 PM to 10:00 PM

Ages 2 to 12 · Junior Academy, 1311 N. Nevada Ave.

Open to the public. You don't need to be enrolled at Junior Academy to join us!

To reserve your child's spot, complete your payment below and then fill out the registration form.

Secure Payment

1 child$35

2 children$55

3 children$75

4 children$95

$35 first child, $20 each additional child.

Number of children:Your total: $35

Secure checkout

You will pay exactly your total above on PayPal.

Registering more than 4 children? Please email enrollment@jracademykids.com and we'll send you an invoice for the total. Then continue filling out the form below.

Payments are non-refundable, as staffing, food, and drinks are scheduled and ordered in advance based on registrations.

1. Child Information

Child's full name

Date of birth

Current home address

4. Health, Allergies & Medical Care

Known allergies (food, medication, environmental)

NoneYes

Dietary restrictions / special feeding needs

Chronic medical conditions, disabilities, or behavioral/care needs

NoneYes

Current medications

Prescription and over-the-counter medications require a separate CDEC medication authorization and provider orders.

Physician / clinic name

Physician / clinic phone

Physician / clinic address

Dentist name

Dentist phone

Preferred hospital / emergency facility

2. Parent / Guardian Information

Parent / Guardian 1

Name

Cell phone

Home / work phone

Home address if different from child's

Parent / Guardian 2

Name

Cell phone

Home / work phone

How to reach you during the event

Restaurant name, venue, or backup phone number where you can be reached.

3. Emergency Contacts & Authorized Pick-Up

Per Colorado licensing rules, children will only be released to parents/guardians or adults listed below who are authorized for pick-up. Authorized adults must be 16 or older. Photo ID is required at pick-up.

Emergency Contact 1

Name

Relationship

Phone

Address

Authorized for pick-up?

YesNo

Emergency Contact 2

Name

Relationship

Phone

Address

Authorized for pick-up?

YesNo

5. Required Authorizations

Emergency Medical Authorization: In the event of an injury or medical emergency where I cannot be reached immediately, I authorize Junior Academy staff to obtain emergency medical or dental care, including transport by ambulance, for my child at my expense.Activities: I give permission for my child to participate in all on-site Parents' Night Out activities (for example crafts, games, and G/PG-rated movies).

Diapering / Topicals

I authorize staff to apply parent-provided diapering cream or ointment as needed.

YesNoN/A

6. Parent / Guardian Signature

I certify that the information above is accurate and complete. I agree to pick up my child by 10:00 PM and understand late pick-up fees may apply.

Parent / Guardian full name (typed as signature)

Date