2. 
4. Event Contact
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Email
18. Secondary Contact
20. First Name
21. Last Name
23. Address
25. City
26. State
27. Zip Code
29. Phone Number
30. Email Address
32. RESERVATION TIME IS 2 HOURS

     You will only be provided 15 minutes max for set-up and 15 minutes max for clean-up. You may also set-up/clean up during allotted 2-hour time while attendant is with children. Additional hours are $95 per hour.

34. Date
    Date
35. Start Time
    Start Time
36. End Time
    End Time
38. Only children are able to participate in the activities Parents are welcome to attend but must remain as spectators.
40. Name of Birthday Child*
41. Age of Birthday Child *
    -- Select One --3 45 67 89101112131415
42. Total Headcount of Participants Only*
44. Choosea Party Package: $50.00 deposit required, unless date is within 30 days full payment is required.
46. SPORTS/GYM PARTY

    1. A: $200.00 NR $250 Includes space (gym), basic setup (table and chairs) and equipment
    2. B: $275.00 NR $345 Includes all of Package A, plusa party attendant to coordinate games.
    3. C: $295.00 NR $375 Includes Package A and B, plus the use of the B/C room for food/gifts.
48. NERF PARTY Participants must bring Nerf Gun Bullets provided.

    1. B: $275.00 NR $345 Includes all of Package A, plus a party attendant to coordinate games.
50. Little Tykes on the Move Children 4 & Under

    1. A: $200.00 NR $250 Includes space (gym), basic setup (table and chairs) and equipment
    2. B: $275.00 NR $345 Includes all of Package A, plusa party attendant to coordinate games.
    3. C: $295.00 NR $375 Includes Package A and B, plus the use of the B/C room for food/gifts.
54. Party Selection

    15 children ($8 per additional child, up to 5 max)Packages do not include napkins, plates, plastic ware, cups, cake, food or drinks.

56. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
58. PLEASE READ THE ROOM UTILIZATION POLICIES AND PROCEDURES AT THE TOP OF THE PAGE. BY SIGNING THIS FORM, YOU AGREE TO ABIDE BY ALL RULES AND REGULATIONS ESTABLISHED BY THE NORTHRIVE RSIDEREC REATION DEPARTMENT AND ASSUME FULL RESPONSIBILITY FOR YOUR GROUP.
60. Electronic Signature*
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field