Halloween Party at Valley Lanes
Presented by Midland Area Catholic Community Youth Ministry!
Date and Time of Event
Sunday, October 30, 2022, 6:00-8:00 pm
Destination
Valley Lanes Family Entertainment Center, 5021 Bay City Road, Midland, Michigan 48642
Supervisors
Christine Sellnow, Kathy Russell, Justin Rose
To which church does your family belong?
*
Please Select
Blessed Sacrament
Assumption
Our Lady of Grace
St. Brigid
St. Agnes
Other
None
Name of Child
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First Name
Last Name
Age
*
Allergies
*
Medical Conditions
*
Medicines child is currently taking
*
Medicines that need to be dispensed during this activity must be given to the designated supervisor in its original container with directions and dosage.
Shoe size (for bowling shoes)
Name of Child 2
First Name
Last Name
Age of Child 2
Allergies of Child 2
Medical Conditions of Child 2
Medicines Child 2 is currently taking
Shoe size (for bowling shoes)
Name of Child 3
First Name
Last Name
Age of Child 3
Allergies of Child 3
Medical Conditions of Child 3
Medicines Child 3 is currently taking
Shoe size (for bowling shoes)
Permission to Participate
I, the parent of the child(ren) listed, request that Blessed Sacrament Parish, Assumption BVM Parish, St. Brigid Parish, and Our Lady of Grace Parish allow my son(s)/daughter(s) to participate in the activity described above. I give permission for my child(ren) to participate in said trip. In consideration for my child(ren)'s participation, I hereby release, save harmless and indemnify Blessed Sacrament Parish, Assumption BVM Parish, St. Brigid Parish, and Our Lady of Grace Parish, its employees, volunteers, agents and any sponsors or benefactors of said trip from any and all liability from any and all injury. I understand that my son(s)/daughter(s) will be under the supervision of the designated supervisor and chaperones on the stated dates and that all parish rules will be in effect. I understand and agree that, if my son(s)/daughter(s) violates a parish rule, he/she/they will be sent home.
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Alternate Emergency Phone Number
*
Please enter a valid phone number.
Medical Release
In case emergency medical treatment is necessary and I am not available to give consent, I authorize the adult advisor in charge to consent to any necessary examination, anesthetic, medical diagnosis, surgery or treatment, and/or hospital care to be rendered to the above-named minor(s) under the general or special supervision and on the advice of any physician or surgeon licensed to practice medicine in the state of Michigan.
Medical Insurance Carrier
*
Policy Contract Number
*
Family Physician
*
Chaperones
We need parent volunteers to help us keep an eye on the kids! The first five parents to sign up can bowl for free! :)
Would you like to chaperone this event?
Yes!
Not this time.
Payment
This event costs $20 per person. The event fee covers bowling for one hour, bowling shoes, pizza, pop, and around $15 of money on a play card to be used on Valley Lanes attractions (laser tag, bumper cars, VR games, arcade, laser maze, and mini-golf). The amount of bonus money that each student receives depends on how many students attend the event. You can pay in advance on the Blessed Sacrament website here: https://secure.myvanco.com/L-Z61G/campaign/C-12WHM
Parent/Guardian Signature
*
Submit
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