Pajama Party

PAJAMA PARTY

Saturday, January 10th 8-10pm
Participant Name 1*

First NameLast Name
Age*
Grade*
Participant Name 2

First NameLast Name
Age
Grade
Participant Name 3

First NameLast Name
Grade
Age
MEMBERNON-MEMBER
Parent's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Email*
example@example.com
Parent's Phone Number*
Emergency Contact Name #1 - (authorized to pick up child)*

First NameLast Name
Emergency Contact #1 Phone Number*
Check in and at the door registrations will begin at 7:45pm.

REGISTRATION FEE: $15/CHILD

50% OFF REGISTRATION WITH PILLOW DONATION TO COMPASSION CONNECTION

PLEASE CALL THE BCC TO COMPLETE PAYMENT (763) 200-4271.

Interested in volunteering? Please contact Dhani Adler at the Becker Community Center for more informartion on volunteering for programs & events!
Statement of Release

I understand that my child must stay for the duration of the program and that I MUST PICK MY CHILD UP PROMTLY INSIDE.

Permission granted for participant to be included in pictures and publicity, (ex. brochures, flyers, Facebook etc.), connected with the BCC with no compensation to me. All pictures and video remain the property of the BCC.

I agree to release the Becker Community Center, City of Becker, their employees and leaders of all liability related to accidents or injuries, which myself or member of my family might incur while participating in the above mentioned activity. Participants in the above mentioned activity are not covered under the Becker Community Center's or City of Becker's medical insurance policy.
Signature*

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PAJAMA PARTY