Sensory.Sensitive.Sundays Chuck E. Cheese’s

Name: Sensory.Sensitive.Sundays Chuck E. Cheese’s
Start: 2017-04-02T09:00:00-05:00
End: 2017-04-02T11:00:00-05:00

April 2, 2017 @ 9:00 am - 11:00 am

CHUCK E. CHEESE'S

Number of CHILDREN attending: LIMIT 3 / child and siblings only*
Please enter a number from 1 to 3.
Adults and additional members can pay day of event.
Name of CHILD*
First Last
AGE:*
Please tell us about your child:*
Please tell us about your child's needs:
- None
- Requires Behavioral Support
- Requires Shadow
- Requires Visual Schedule
- Non-Verbal
- Sensitive to Noise
- Other: Please let us know in comments
Address*
Street Address City State ZIP Code
Parent's Name*
First Last
Cell Number:*
Email:*
Comments/Additional information:
Informed Consent and Acknowledgement*
I hereby give my approval for my child’s participation in any and all activities organized by TEAM MARIO I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless TEAM MARIO, and all its respective officers, agents, directors, sponsors, volunteers, and representatives from any and all liability for injuries to said child arising out of participating in event.

In case of injury to said child, I hereby waive all claims against TEAM MARIO, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, executive board, directors, volunteers and, if applicable, owners and lessors of premises used to conduct the event.
- I agree