Birthday Party Request Form

Child's First Name

Child's Last Name

Child's Date of Birth

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

Are you a Springfield JCC member?

Yes No

If you currently are NOT a member, are you interested in becoming one?

Yes No

What Party Theme are you interested in?

Pool Party Sports Party Arts Party Room Rental only

If you selected Sports Party, please select up to two sports from the list below:

Basketball Soccer Dodgeball Gagaball

If you selected Arts Party, what subject would your child be interested in (example: favorite animal, favorite cartoon, etc.)

How many total guests are you anticipating, including yourself and your child?

What is your ideal date for this birthday party?

What is your 2nd choice for a date for this birthday party?

Additional Notes: