Laser Quest Event Consent & Registration Form

Potential Unlocked – Laser Quest Event Consent & Registration Form!
Join Us for the Potential Unlocked Laser Quest Social!

📅 Saturday, 12th October | 6:00 PM - 8:30 PM
📍 Star City, Nechells, Birmingham B7 5SA

Get ready for an unforgettable evening of fun, excitement, and forging powerful friendships with peers who are on the same journey to unlock their full potential! At Potential Unlocked, we are all about helping your child achieve the grades they deserve while nurturing their God-given talents for greatness. This is more than just a game—it's an opportunity to build a community of high achievers who are determined to live a fulfilled, successful, and transformed life!

🎯 What’s Included?
- Two exhilerating games of Laser Quest—completely on us!
- A post-game treat at McDonald's—our way of saying "well done!"

And here's the best part: your child can invite a friend from school to join the fun, and we’ll cover their costs too!

All we ask is for a refundable deposit of £15.00 by Thursday 3rd October, to secure your child’s place. The deposit will be refunded back to your debit/credit card on Monday 13th October 2024. Don’t miss out on this incredible chance to encourage friendships, inspire greatness, and have a blast while doing it!

🚀 So, what are you waiting for?
To secure your child’s spot, simply fill out the form below. If you have any questions, feel free to contact us at 0121 405 0853.

Let’s unlock potential together!
Parent/Guardian Information
Full Name of Parent/Guardian*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Student Information
Full Name of Student*

First NameLast Name
Age of Student*
Friend Invite Information
Full Name of Friend*

First NameLast Name
Friend's Parent/Guardian Full Name*

First NameLast Name
Guardian’s Email Address*
example@example.com
Guardian Phone Number*
Please enter a valid phone number.
Medical Information
Does your child have any allergies or medical conditions?

YesNo
If Yes, Please specify allergies/medical conditions*
Emergency Contact Information*
Please enter a valid phone number.
Event Consent
I, First Name Last Name, give my consent for my child Student’s Name, to participate in the Laser Quest Event hosted by Potential. I understand that this event involves physical activity, and and while all reasonable precautions will be taken, I agree that Potential Unlocked and its representatives will not be held responsible for any injury, accident, or loss that may occur during the event, except in cases of negligence.

By attending the event, I also give my consent for Potential Unlocked to take photos during the event to promote future events for the Potential Unlocked community. I understand that these photos may be shared on the website, newsletter, and social media platforms.

I understand that my personal information and any photos taken at the event will be handled in accordance with Potential Unlocked's data protection policy and will not be shared with third parties without my consent.

I agree to discuss appropriate behaviour with my child prior to the event. I understand that disruptive or unsafe behaviour may result in my child being asked to leave the event.

I understand that the £15.00 deposit will be refunded to my debit/credit card on Monday 13th October 2024, provided my child attends the event. Should my child not attend without prior notice, the deposit may be forfeited
Parental Consent*

Yes, I agree to the above terms.
Payment Details
Waiver of Liability
I First Name Last Name , release Potential Unlocked from any and all liability in connection with my child’s participation in the Laser Quest event. I confirm that my child is in good health and capable of participating in physical activities.
blank
Liability Waiver Agreement*

I agree to the terms and conditions of the Liability Waiver.
E-Signature Consent
Electronic Signature Consent*

By signing below, I understand and agree to the terms of this consent form and confirm that the information provided is accurate.
Guardian’s Full Name*

First NameLast Name
Date of Signature*

DayMonthYear
Date
E-Signature*

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My Products*

Card Terminal Refundable Deposit once event has attended.

£15.00 Quantity

Total

£0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Potential Unlocked – Laser Quest Event Consent & Registration Form!

Parent/Guardian Information

Student Information

Friend Invite Information

Medical Information

Event Consent

Payment Details

Waiver of Liability

E-Signature Consent