SPECIAL NIGHT FOR SPECIAL KIDS
Registration Form

Family Name_____________________________________________________________
Address_________________________________________________________________
City_______________________________State_________________Zip_____________
Phone___________________________________________________________________

Special Child _____Boy _____Girl
Wheelchair _____Yes _____No
Other Children Attending_________________

How did you hear about “Special Night for Special Kids”?

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Complete this form and return to Village Hall or mail to:

Village of South Elgin/Special Events Committee
10 N. Water Street
South Elgin, IL 60177

For additional information, please call the hotline at 847-774-1151