Family Fun Night Signup - Lakes Region Community Services

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Family Fun Night 2023

Primary Contact Name*
First Last
Primary Contact Phone*
Primary Contact Email*

City/Town of Residence*
City

Have you or a member of your family participated in Family Resource Center services/programming in the last two years?*

Yes

No
Which Services or Programs (check all that apply - hold control down to choose multiple)*
Which Program?

Which of our staff members is most familiar with your family?

Family Fun Night will be held on Monday, December 11, 2023. Please choose the time that your family would like to arrive.*

3 pm

4:30 pm

6 pm
Please list all adults who will be attending. Click the plus sign to add additional names*
Adult Name Date of Birth

Please list all children who will be shopping. Click the plus sign to add additional names.*
Child's Name Date of Birth

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