First Name

Last Name

Email Address*

Phone

Social Media (Facebook, Instagram, Twitter)

Community Event

Word of Mouth (Friends or Family)

Rinks Employee

Other (please specify below)

If Other, please specify

Preferred Date (Format: 01/01/2019)*

Please pick a Public Session (Times are subject to change)*11:30am (Mon-Fri)1:00pm (Sat & Sun)3:30pm (Mon-Fri)7:00pm (Fri, Sat)9:30pm (Fri, Sat)

Please pick a restaurant reservation time (Available either one hour before or after a Public Sessio*One hour beforeOne hour after

Decoration Colors (Select up to three - N/A with Ducks theme)BluePinkWhiteGoldOrangeBlackSilverDucks Theme

Message On The Cake*(WRITE EXACTLY WHAT SHOULD BE SAID ON CAKE/CONFIRM SPELLING OF NAME)

Logo*DucksFigure SkateFlowersConfettiPrincessHockey SkateSports

Ice Cream Flavor*Vanilla & ChocolateVanillaChocolate

Middle Layer*Chocolate & Fudge CrunchVanilla Cookie

Drinks Options (No Limit)RC ColaRC Diet ColaDr. PepperSquirtSunkistWaterRoot Beer7 UpLemonade

Pizza 1PepperoniSausageMushroomsOnionsBlack OlivesBBQ ChickenBaconExtra Cheese

Pizza 2PepperoniSausageMushroomsOnionsBlack OlivesBBQ ChickenBaconExtra Cheese

Pizza 3PepperoniSausageMushroomsOnionsBlack OlivesBBQ ChickenBaconExtra Cheese

Do you want a zamboni ride?NoYes

Additional Skaters? (Cost: $21.95; specify number 0-40)

Additional Non-Skaters? (Cost: $10.95; specify number 0-40)

CommentsLast day to add people and food is Monday prior. No Refunds the day of the party