Party Request Form HiddenBirthday SectionDisclaimer – Please Be Sure To Review Our Birthday Party Payment And Cancellation Policy Before Completing This Form. Name of Contact Person* First Last Relationship to child* Birthday Child Name* First Last Age Child is Turning* Child 2 Favorite Colors* Contact InformationAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Contact Phone*Billing Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of Students* Grade Level* HiddenPackage TypeChoose a package*Choose ---Super Miner PackageAmazing Miner PackageUltimate Miner PackageSuper Miner Package $150.00 6 Regular Buckets Gemstone Goodie Bags Miners Helmet or T-Shirt (Birthday Child) Gemstone Collection Box (Birthday Child) Amazing Miner Package $200.00 10 Regular Buckets Gemstone Goodie Bags Miners Helmet or T-Shirt (Birthday Child) Gemstone Collection Box (Birthday Child) Special Rock Specimen (Birthday Child) Ultimate Miner Package $275.00 15 Regular Buckets Gemstone Goodie Bags Miners Helmet or T-Shirt (Birthday Child) Gemstone Collection Box (Birthday Child) 2 Special Rock Specimens (Birthday Child) CRGM Birthday Party Add OnsT-shirt for All Kids (10.00 Per T-shirt) Youth Small Youth Medium Youth Large Adult Small Balloons & Decorations ($50.00) 1 Dozen Balloons and Streamers, Plates, Cups & Napkins Cupcakes 1 Dozen ($20.00) 2 Dozen ($40.00) None Assorted Juices 1 Dozen Assorted Juices ($15.00) 2 Dozen Assorted Juices ($30.00) None Assorted Sodas 1 Dozen Assorted Sodas ($15.00) 2 Dozen Assorted Sodas ($30.00) None Extras Add An Extra Bucket & Treat Bag $12.00 Food and Drink you will be bringing:*Type of Decorations you will be bringing:*Special Instructions or Needs(We will do our best to accommodate any special requests or needs your party may have) Date InformationWhat Date and Time would you like to request? (Please list your top 3 choices) Date Option 1* MM slash DD slash YYYY Date Option 2* MM slash DD slash YYYY Date Option 3* MM slash DD slash YYYY Party Time Preference?* : Hours Minutes AM PM AM/PM Review & ConfirmPlease review the Birthday Party Payment And Cancellation Policy before proceeding.Do you agree with the above-mentioned policies.* I agree NameThis field is for validation purposes and should be left unchanged.
