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GOMPTY Goes to Dave & Busters!
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J
oin 4th, 5th & 6th grade friends for an afternoon at Dave & Busters in Thousand Oaks on March 17
2:00 pm - 5:00 pm
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All 4th, 5th, and 6th graders are invited to join us for a fun afternoon of games and fun with your GoMPTY community.
$30 covers the cost of laser tag, game play, and staff supervision.
Please send any questions to
rachel@orami.org
.
We hope to see you there!
REGISTER BELOW
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Parent Name:
*
Email:
*
Phone Number:
GOMPTY 4-6th Grader Info
*
Child's Name
*
Select Grade
Please Select One
4th Grade
5th Grade
6th Grade
*
Check to add to cart ($30)
Check to add to cart ($30)
Child's Name
Select Grade
Please Select One
4th Grade
5th Grade
6th Grade
Check to add to cart ($30)
Check to add to cart ($30)
Child's Name
Select Grade
Please Select One
4th Grade
5th Grade
6th Grade
Check to add to cart ($30)
Check to add to cart ($30)
Child's Name
Select Grade
Please Select One
4th Grade
5th Grade
6th Grade
Check to add to cart ($30)
Check to add to cart ($30)
*
Any Allergies?
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Any allergies or food allergies?
*
Additional Emergency Contact - Full Name:
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Emergency Contact Cell Phone:
Emergency / Liability Form
Please fill out the following information in case of emergency.
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Please type your full name to sign the liability waiver
I/we hereby give permission for my/our teen to participate in Congregation Or Ami's Youth Group Event, and agree to release and hold harmless Congregation Or Ami, its Rabbis, cantor, educators, staff, board members, leaders, and its representatives from all costs, damages, claims, causes of action, losses and liability arising out of or related to my/our teen’s participation in, or transportation to/from/during, this activity. Moreover, I/we hereby assume all risks inherent in or associated with my/our teen’s participation in, or transportation to/from/during, this activity. In the event of an emergency or the sudden illness of my/our teen occurring when I/we cannot be reached, I/we also give my/our consent for my/our above-named teen to be treated by such emergency medical personnel, doctors and/or hospitals, as are selected by Congregation Or Ami. I/we understand that in the event of such emergency, Congregation Or Ami will make reasonable efforts to consult with the physician or medical group named above, but the nature of the emergency may require treatment be undertaken before such consultation is possible. Congregation Or Ami does not accept responsibility of loss, damage to, or theft of the teen’s property. I HAVE READ AND FULLY AGREE TO THE TERMS ABOVE.
*
Date:
Total:
Thu, December 26 2024
25 Kislev 5785
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Thu, December 26 2024 25 Kislev 5785
