Registration
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Family Information
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Emergency Contact Info
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kindergarten
1st grade
2nd grade
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4th grade
5th grade
6th grade
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college
college-freshman
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Student's First Name:
*
Last Name:
*
Birth Date:
*
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Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
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Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Add New Student #5:
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Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
School:
Grade Level:
preschool
kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
college
college-freshman
college-sophomore
college-junior
college-senior
Unknown value
Disabilities (Leave blank if NONE):
Allergies (Leave blank if NONE):
Medications (Leave blank if NONE):
Questions/Options:
PLEASE SELECT YOUR PARTY TYPE Below:
(checked=yes)
Party 1: All-Star 2 Hour Party: $299 Total $125 deposit due at booking, $174 due week of the event
Party 2: Twinkle Star 1.5 hour Party:$225 Total $100 deposit due at booking, $125 due week of the event
(checked=yes)
Party 3: Princess Party: $339 Total $125 deposit due at booking, $214 due week of the event
Party 4: BLASTER Party : $349 Total $125 Deposit due at booking, $224 due the week of the event
(checked=yes)
Birthday Child Name: (Age turning) : Final guest count: Kids: _____ Adults: _____ b-day name:
*Please note: WE NO LONGER PROVIDE THE SERVICE OF ORDERING PIZZA THROUGH US. Should you wish to have pizza delivered to your party we recommend Domino's or Pizza Guys on Rob Drive.
What outside food is the party host bringing? (No additional Charge) Any food deliveries by the party host family, must be arranged with a delivery of 10 minutes BEFORE entering the party room.
I understand that if we bring/deliver outside food we cannot adjust our party time to accommodate a late delivery.
Yes
No
Would you like to add a Party Convenience Package for $25? Includes: table covers, plates, napkins, utensils in, Should you provide your own PLEASE PREPARE TO COVER 5 TABLES
Yes
No
Please verify that you understand all drinks are to be self contained. No 2-liter bottles or anything requiring cups. Juice boxes, cans, water bottles are acceptable. Alcohol is strictly prohibited.
Yes
No
I understand that alcoholic beverages are not permitted at the party or within the building/parking lot of Jump N Shout.
Yes
No
Is the guest bringing any outside vendors such as characters, face painters, clowns? Please describe and include special instructions.
Additional information the staff needs to be aware of for this party
OFFICE USE ONLY: Party Confirmed - Date: _______ By: _____ Pizza Ordered: __________ Delivery Time: __________ Ordered by: __________
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Amex
Name as it appears on card:
*
Nickname:
Card Expiration Month:
*
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Exp Year:
*
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Address Line 1:
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MT
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Zip:
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