Party Date ______/_____/______   Party Time_____ - ______  Staff Contact: __________________________________  

Birthday Child’s Name: ________________________________________________Date of Birth:___________________

Parent/Guardian:___________________________________________________________________________________

Address:_______________________________________________ City:_____________________ Zip:______________

 Day Phone: ___________________ Evening Phone: ______________________  Cell Phone:_______________________

 Email: _____________________________________________________________________

Number of Guests ______                                                 Birthday Child T-shirt size: ___________

o    KIC Staff for help with field time:    1 hour  X $25 ______  Time Needed:_____________

Large 1 Topping Pizza _______            Additional Pizzas X $14 per pizza: # of pizzas ________

o cheese ___    o sausage ___    o pepperoni ___

Pitchers of Pop: o Sprite ____  o Coke ____  o Root Beer ___  Additional Pitchers $3 each

No alcoholic beverages may be served. Absolutely no OUTSIDE food, beverages, candy or gum are allowed at KIC.  KIC reserves the right to approve decorations. No Helium balloons or floatable items.  Minors must be accompanied by at least one responsible adult per every group of three children during an event. Kingdom t-shirts and sweatshirts are available for purchase for party favors.

Payment Information:

Please make checks payable to KIC, 8151 Merchant Place, Portage MI  49002

A 50% non-refundable deposit is due at party reservation.

Birthday Charge $99     (with staff add $25)            $ _____

Pizzas (1 complimentary)      # of extras ___X $14            $______

Extra Pitchers of Pop     # of extras ___X $3              $ _______

Total due:         $_____________

 50% deposit      $_____________Date: _______

Balance due:     $_____________ Date:________

Credit Card # - ____________________________________________  Expiration Date:  ________________

Release of Liability & Medical Consent

I, the undersigned, acknowledge and agree that attending or participating in sports may be hazardous and may result in injury. I further agree that I assume all risks

of injury for myself and anyone who comes with me to the premises incurred or suffered while upon the premises or as a result of using the facilities or equipment

therein. I further expressly agree to release KIC, its owners, employees, agents, successors, assigns, affiliates and anyone else associated with KIC from any and all

claims, demands or damages whatsoever, whether developed or undeveloped, known or unknown, anticipated or unanticipated, have, now or in the future, including,

but not limited to any and all claims, demands or damages for negligence, personal injury and/or loss, theft or destruction of personal property. It is my intention that

this release is as broad as Michigan law allows releases of this sort to be. I understand that, without this document, the cost of participation would necessarily be

greater, and I also acknowledge that I may obtain insurance to protect myself if I so choose. I further agree to save, hold harmless, and indemnify KIC, its owners,

employees, agents, successors, assigns, affiliates, and anyone else associated with KIC from any and all claims, demands or damages, including cost, interest and

attorneys’ fees which they may suffer or incur as a result of any claims by me, anyone who comes with me to the premises, or related entities, and/or as a result of any

claims, demands or lawsuits arising out of my actions or those of anyone who comes with me to the premises.

I HAVE READ THE FOREGOING RELEASE, I FULLY UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT. ______________________________________