Single Event Program Registration

Participant Information

Participant's Name *

First Name Last Name

Grade Level *

Age *

Additional Student's Name (optional)

First Name Last Name

Age *

Grade Level *

Additional Student's Name (optional)

First Name Last Name

Age *

Grade Level *

Are you members of the MESS Hall? *

Yes No

Please enter member code for discount

Please email info@pensacolamesshall.org if you forgot the code

Which program? *

Fossil Hunt is included with admission. Admission is $8 per person ages 3 and up, including adults. No child is admitted without an adult over 18.

Saturday Night Science programs are not drop off programs. All children must be accompanied by an adult. Please add at least one adult.

TinkerTotsSept

SNS Child nano

SNS Adult nano

TinkerTotsOct

TinkerTotsNov

TinkerTotsDec

SNS Adult robot

SNS Child robot

Member

MemberNights

Total

Total Fall 2017 Cost

USD MESSHall2017Programs

Have you attended a program at the MESS Hall before? *

Yes No

Parent/Guardian Information

Name *

First Name Last Name

Main Number *

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *

Informed Consent and Acknowledgement

In consideration of my child’s participation in programs provided by the Pensacola MESS Hall, I indemnify and hold Pensacola MESS Hall and its affiliates, employees and agents harmless from and against any and all liability for negligence or medical expenses resulting from my child’s participation in such programs or other activities. I further release Pensacola MESS Hall and its affiliates, employees and agents from any and all negligence or other claims resulting from my child’s participation. I further understand that Pensacola MESS Hall does not provide medical insurance coverage for my child and that any medical expenses incurred will be paid by either my own medical insurance or myself. I hereby grant permission for my child to participate in all activities.

I give permission for my child’s photo and/or likeness to be retained and used by Pensacola MESS Hall without any remuneration or compensation.

Cancellation Policy & Tuition Refund

If a cancellation occurs…	Amount Refunded
5 or more calendar days before a program is scheduled to start (includes the weekend)	100%
1 to 4 calendar days before a program is scheduled to start (includes the weekend)	50%
Due to a no-show on the day the program is scheduled to start or subsequent days	0%

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Saturday Night Science is not a drop off program. All children must be accompanied by an adult. Please add at least one adult. The Submission button will appear when this is corrected.

Fall 2017 Program Registration