First Name

Last Name

Email Address*

Phone

Birthday Guest Name

Age

Birth Date

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)*

Decoration Colors (Select up to three)RedOrangeYellowGreenBluePurplePinkBlackWhiteBring My Own**Please notify staff of drop-off day and time. Must be dropped off at least one day prior to party.

Name of Birthday Guest of Honor*

Type of Cake*VanillaChocolate

Cake Decoration*BalloonsFlowers

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

Special Requests/Comments (Gluten Free?)

Choose below:CheesePepperoni

Twenty minute lesson:NoYes*$30.00 plus tax

Additional Skaters? (Cost: $10.00; specify number 0-40)*Includes pizza, cake, water/juice, decorations and skating

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