Laser Tag Event

Laser Tag Event

Hosted by Empower Youth for grades 7 to 12
Join us for our laser tag event night!

When: Friday, February 27th

Time: 6pm to 9pm

Where: Gregory Drive Alliance Church

Cost: $15 per person

Cash can be turned in directly to Jessica Fieldus, or you may etransfer to office@gregorydrive.com *note 'laser tag'

Come out and join us for a fun evening of laser tag, food, and other games!

Everyone currently in grades 7 to 12 are welcome. Please fill out the information below to register.
Student Name*

First NameLast Name
Grade*
Student E-mail
example@example.com
Additional Comments
Parent/Guardian Information
Name*

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

If Parent/Guardian is unreachable for any reason, this person will be contacted.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to Student*
Liability and Waiver
I,parent/guardian, the parent/guardian of student listed above, give permission for my child to attend the Gregory Drive Alliance Church Empower Youth laser tag event on Friday, February 27th, 2026. initial
As part of the event, I am aware that there will be physical activity, fog, and flashing lights involved. Should this be of concern for my child, it is my responsibility to let the leadership know of any and all concerns. initial
I, parent/guardian, am the parent/legal guardian of the student named above. I acknowledge and understand that participation in the activity listed above involved inherent risks of injury or harm. These risks may include, but are not limited to, physical injury, illness, or accident. initial
I hereby release and hold harmless GREGORY DRIVE ALLIANCE CHURCH, LASER TAG TOGO, its employees, leadership, volunteers, and representatives, from any and all liability from injuries, damages, or losses, arising out of or related to the students participation in the above-mentioned activity whether caused by the negligence of the company or otherwise. initial
In the event of an emergency, I understand that all attempts will be made to reach me. However, if I am unreachable, I consent to the authorization of appropriate care from the leadership and authorized medical personal. I understand that I will be responsible for all costs associated with treatment. initial
Photo/Video Release
I grant permission for the students likeness to be used in photos and videos taken during the activity for promotional and informational purposes by GREGORY DRIVE ALLIANCE CHURCH. initial
By signing this form, I acknowledge that I have read the full form, understand its contents, and agree to the terms and conditions.

By signing, I agree to register my child for the Empower Youth Laser Tag event on Friday, February 27th of 2026, and agree to pay the $15 per person prior to the event.
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Laser Tag Event

Parent/Guardian Information

Emergency Contact

Liability and Waiver

Photo/Video Release