Back-to-School Bash at Valley Lanes!
Date and Time of Event
Thursday, August 14, 2023, 2:30-4:30 pm
Cost
For $20, students can bowl for one hour, have pizza and pop, and then have one hour to use the other attractions at Valley Lanes, such as mini-golf, bumper cars, the laser maze, the arcade, etc. One or two of the attractions are included in the $20 fee. (The number of things they can do depends on their choice of activities as each activity costs a different amount.) Students should bring extra money if they want to use more attractions or to play in the arcade. You can bring the $20 with you to Valley Lanes on the 14th.
Destinations
Valley Lanes Family Entertainment Center, 5021 Bay City Road, Midland, Michigan 48642
Supervisors
Christine Sellnow, Kathy Russell
Name of Child
*
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.
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
Permission to Participate
I, the parent of the child(ren) listed, request that Blessed Sacrament Parish, Assumption BVM Parish, and St. Brigid 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, their 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
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Alternate Emergency Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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
*
Parent/Guardian Signature
*
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