Please provide what option(s) you want and the amount, up to 2 per family.
Quantity. _____ Afternoon Tea. _____ Party Package - Drink, appetizer, entry,
cake ...
American Girl Doll Trip Form - November 17th Name: ________________________________________ Phone Number: ________________________________ Email Address: ________________________________________ Daughters’ Names(Limit 2): ______________________________ ______________________________ Please provide what option(s) you want and the amount, up to 2 per family Quantity _____ _____
Afternoon Tea Party Package - Drink, appetizer, entry, cake & goodie bag
_____
Transportation
Packages
3 Family Members(2 girls) 2 Family Members
Party Package(Includes pink lemonade, appetizer, entry and dessert plus a goodie bag) & Transportation
$130
$80
Afternoon Tea & Craft & Transportation
$80
$65
Transportation
$70
$55
*If additional family members wish to participate, please talk to Jessica McClelland at the library for possible arrangements. Please enclose a check with this form in a sealed envelope addressed to Jessica McClelland at 730 W Grant Street Houston, PA 15324 or deliver it to the library addressed to the name above. CHECK #_______________________________
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TRAVEL WAIVER: I understand that participation in trip activities could involve risk of physical injury, illness, death or property loss, and despite safety precautions, the library cannot guarantee safety thereof, as all risks cannot be prevented. Chartiers-Houston Community Library does not provide health and accident insurance for trip participants and I understand that any medical expenses, property loss or other personal expenditures that result during or from this trip are to be borne by the participant or by their parent or guardian. I also hereby consent and give authorization to trip leaders to secure any emergency medical treatment in even I am unable to, and I agree to be responsible for the costs thereof. In consideration of the opportunity afforded, with full knowledge and acceptance of risks associated with this travel and trip activities, and with full understanding of above issues/conditions, I hereby release, indemnify and hold harmless Chartiers-Houston Community Library and its agents from all form and manner of risks inherent in such travel and from all claims and demands of any nature arising from participating in said trip.
Signature: _____________________________________________ Date: _________________________
Emergency Contact: Name: ________________________________ Any Medical Needs?:
Phone #: ____________________________________
