Movie Night Luau Back to School Bash

Child's Name

Parent/Gaurdian Name

Parents Phone

Child's Address

How old is your child?

You are aware and agree that if under the age of 3 you must be present with your child for this event?

yes no

Childs Birthday

Parent/gGaurdian Email

This address will receive a confirmation email

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Address

Is there anything that we should be aware of or know about your child?

I would like to make a donation for this event to Mt Zion Church.

Amount

Mt Zion's number one importance is the safety of your child. However there are rules and guidlines of Mt Zion that we need to know will be followed by all parties involved. We are not relieable for lost, stolen or dameged personal items. Any damage intentionally done will be parents responsibilty. Anger and voilence will not be tolertaed and parents will be called to pick up child immediatlly and parents will do so. We want to unsure the safety of all children. We expect them to be excited and have a blast while they are here. Backround Checks have been done for the staff of Mt Zion and more than one adult with cleared backround check will be on primises at all times. You are aware that you wil need to walk child into the event for check in and return at pick up time if you choose not to stay. you give permission for your child to be photographed, eat snacks provided, and get in the water (no pools). We look forward to this fun event and hope you and your children do as well. If you agree or disagree the box below is provided for you to indicate yes if you agree and no if you do not.

Agreement for above statement.

Yes I agree NO I do not agree

Any Comments or Concerns?

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.

Movie Night Luau Back to School Bash

Description

Please Fix the Following