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Date____________________
Parents ______________________________________________________________
Grandparents _________________________________________________________
(2 Sets ) _________________________________________________________
Children's Names & ages (Under age 18 who live in your home)
1. ____________________________________
2.____________________________________ 3.____________________________________
4.____________________________________ 5.____________________________________
6. ___________________________________ 7.___________________________________
Address______________________________________________________________________
_________________________________________________zip___________________________
Phone#___________________________________
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Family $49.50 * Mom, Dad, all children who live in the home
Family Plus $59.50 * Family plus 2 sets of Grandparents
Add 1 $10.00 *Admission for 1 extra person per visit
Grandparents $59.50 *1 set of Grandparents and all grandchildren
Caretaker $59.50 * 1 Adult and up to 6 children (Home Daycare Lisc)
Membership is good One Year from date of purchase.
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CREDIT CARD AUTHORIZATION
Please Print Information as it Appears on Your Credit Card
Name________________________________________________________________
Address_____________________________________________________________
__________________________________________-zip________________________
Choose one: Master Card / Visa / Discover
Expiration Date __________________
Last Three #'s on back of Credit Card ___________________
Phone #__________________________________________
Today's Date_____________________________________
By signing below you agree to authorize the Hand's On Children's Museum to charge your credit card above the following amount:
Memberships $49.50 / $59.50 / $69.50
Birthday Party Deposits $50.00 / $75.00
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Charge is non-refundable and non-transferable. Cardholder acknowledges receipt of sevices in the amount of the total shown and agrees to perform the obligations set forth to the Cardholder's agreement with the issuer.
______________________________________________ signature
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BIRTHDAY PARTY DEPOSIT
NAME_______________________________________________________
BIRTHDAY CHILD'S NAME__________________________________
DATE OF PARTY ___________________________________________
TIME OF PARTY ___________________________________________
TABLES RESERVED: 1 table, 1&1/2 tables, 2 tables, 3 tables
I have read the BIRTHDAY PARTY information on the web site and agree.
copy and e-mail to hocm2000@bellsouth.net
THANK YOU FOR CHOOSING THE
HANDS ON CHILDREN'S MUSEUM!
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