Party Form

Name

Address

City

State

Zip

Phone

Party is For

Celebrating

Adult or Child

Adult Child

Age

Party Date

Alternate Party Date

Party Time

Number of Kids

Number of Adults

Package 1

8-12 GUESTS
SHARED PARTY AREA
$250 + TAX + 10% SERVICE FEE
2 PIZZAS, 1 PITCHER OF SODA
PRICE INCLUDES *8

Package 2

8-12 GUESTS
SHARED PARTY AREA
$300 + TAX + 10% SERVICE FEE
2 PIZZAS, 1 PITCHER OF SODA, LIMBO
AND ARCADE TOKENS!!!!
PRICE INCLUDES *8

Package 3

15-45 GUESTS
PRIVATE PARTY ROOM
$500 + TAX + 10% SERVICE FEE
4 PIZZAS, 2 PITCHERS OF SODA,
100 ARCADE TOKENS
PRICE INCLUDES *15

Which package are you interested in?

Package 1 Package 2 Package 3

Would you like an extra pie(s)?

Yes No

How Many?

ANY DIETARY RESTRICTIONS?

Yes No

Tell us about your dietary restrictions.

ADD ONS YOU’RE INTERESTED IN (SEE PRICING ON SEPARATE SHEET)

Notes

*PLEASE NOTE: WE DO NOT PERMIT OUTSIDE FOOD OR BEVERAGE. YOU ARE WELCOME TO BRING BIRTHDAY CAKE OR CUPCAKES. *PLEASE NOTE: WE RENT SKATE MATES INDIVIDUALLY FOR $4. SKATE MATES ARE NOT AVAILABLE ON SATURDAYS 5PM-10PM.

I ACKNOWLEDGE THAT I HAVE COMPLETE UNDERSTANDING OF THE POTENTIAL RISK ASSOCIATED WITH THIS ACTIVITY, INCLUDING INJURY AND DEATH AND I VOLUNTARILY AGREE TO ASSUME ALL SUCH RISK. I HEREBY RELEASE, DISCHARGE, INDEMNIFY, AND AGREE TO SKATE TIME AND EMPLOYEES, HARMLESS FROM AND AGAINST AND AND ALL LIABILITY. CLAIMS ACTIONS, SUITS, DAMAGES, LOSSES, OR INJURIES OF ANY KIND, NATURE, OR DESCRIPTION, INCLUDING WITHOUT LIMITATION PERSONAL INJURIES AND/OR DEATH, MEDICAL EXPENSES, AND ECONOMIC DAMAGES ARISING OR CLAIMED AS A RESULT OF ANY ACT OR OMISSION.

SIGNATURE OF PARENT/GUARDIAN

Package 1

Package 2

Package 3

5164 US Highway 209
Accord, NY

Thank you for your party form submission!

Party Form

Package 1

Package 2

Package 3

5164 US Highway 209 Accord, NY

Thank you for your party form submission!

5164 US Highway 209
Accord, NY