Youth Laser Tag

Wednesday, Jan. 14 6-7:30pm we will play Laser Tag at Andy B's with students in 6th-12th grade!

Drop off and pick up will be at Andy B's.
1127 E. Battlefield Rd
Springfield, MO 65807

Cost is $10 a student: Pay through the form or bring cash (exact change) that night. If a student can use financial assistance, please contact Paul at p.ragon@firstandcalvary.org or 731-414-6419.

Parents and Guardians, please fill out one form per student

Student First and Last Name

Parent/Guardian First and Last Name(s)

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

Alternative Emergency Contact Phone Number

Address

Describe medical concerns, allergies, and other information that will help us best serve your child. If your child has special needs please describe those here.

Student Phone Number

Student Grade

6th 7th 8th 9th 10th 11th 12th

By attending student understands that their participation is a privilege. Students must stay in supervised areas and show respect to all students and adults. If my child is not following these rules, then I understand I may be asked to pick up my child immediately or if I am unable to be reached, then a leader has my permission to either drive my student home.

I agree

By typing my name, I, the parent or guardian of this child, give permission for First and Calvary Presbyterian Church staff and leaders to call emergency personnel and give appropriate treatment for my child/children in the event I cannot be reached during a medical emergency. I agree for minor first aid to be given (like band-aids applied to cuts, etc.). I also give permission for my child/children's picture in newsletters, promotional tools like brochures, social media, or other uses deemed appropriate by First and Calvary Presbyterian (we will never post children's names). I understand that I, the parent or guardian, have financial responsibility and liability for my child's illness or injury while in the care of First and Calvary.

Activity Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Youth Laser Tag

Description

Please Fix the Following