Impulse Birthday Party Request Form

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Fill out the form below to request a birthday party at Impulse! All parties include invitations, set up, clean up, plates, silverware, and goodie bags! We reserve SATURDAYS and SUNDAYS anytime after 11am for Birthday bookings. Both packages are 1 hour and 15 mins (added time is available)

Email *

Phone Number *

Parent's First and Last Name *

Birthday girl/boy name *

Age they will be turning *

Preferred Date (Please list at least two Saturdays or Sundays) *

Select a Theme *

Frozen

Encanto

Glow Party

Ballerina/Ballerino

Select Add Ons *

$20 - Pizza (8 pieces)

$10 - per additional guest

$20 - Special Rhinestone Birthday Tiara

$20 - Special Princess Set (complete with tiara, wand, gloves and necklace)

$15 - Birthday Sash

$20 - per additional 15 min ( total of 2 hour limit)

$10 - Themed Craft per guest

None

Required

If you are requesting additional time, please let us know how much time you would like *

How many guests, including the Birthday Child, will you be expecting? *

Please let us know if you have any questions, special requests, allergies or any specific accommodations you may need *

WAIVER AND RELEASE OF LIABILITY FOR PARTY PARTICIPANTS In consideration of participating in any way with Impulse Dance Academy (Hereafter referred to as “The Studio”) and/or in any performance/athletic/recreational programs and related events, the undersigned does hereby:• Give consent that any photo media taken of participant in connection with “The Studio” may be used for publicity, promotion or television and waive competition in regard thereto. • Fully understand that any medical treatment given will be of a first aid nature only.• Understand that the participant/s will be engaging in activities that may cause injury and/or disability. Further, there may be other risks not known to us or not foreseeable at this time. Participant/Parent/Guardian assumes all the foregoing risk and accepts personal responsibility for the damages following such injury/disability.• Acknowledge that “The Studio” shall not be liable for any injuries and/or damages to any participant, client, member, member’s relative or visitor, or the property of the above aforementioned, or shall be subject to any claim, demand for injury or damages whatsoever, including, without limitation, those damages resulting from acts of active or passive negligence on the part of “The Studio”, their officers or agents. • Acknowledge “The Studio”, shall not be responsible for any lost or stolen articles including but not limited to automobiles and the contents thereof.• Release, waive, discharge, covenant not to sue and release from any and all liability all claims and demands for loss of property, damages and injury “The Studio”, their owners, employees, agents or executors.• *

I have read, fully understand and agree to the statements above

Required

A copy of your responses will be emailed to the address you provided.

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