Jr. High River City Extreme| January 28th 5-7 pm
1/15/23 5-7 pm | Please fill out this form and click submit.
Jr. High youth are welcome to meet at River City Extreme in Monticello Sunday, January 28th from 5-7 pm for unlimited bowling, arcade, and laser tag! Cost is $20 but bring extra money if you’d like to buy any food or drink. Friends are welcome!
Name(s)
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Parent Email
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Parent Phone
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Payment
Credit/Debit 1 Youth ($20.00)
Credit/Debit 2 Youth (40)
Credit/Debit 3 Youth (60)
Credit/Debit 4 Youth ($80)
Cash/Check (0)
Credit/Debit 1 Youth ($20.00)
Credit/Debit 2 Youth (40)
Credit/Debit 3 Youth (60)
Credit/Debit 4 Youth ($80)
Cash/Check (0)
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Credit/Debit Card Number
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Name on Card
Card Billing Address
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BC
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CO
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DE
FL
FM
GA
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IA
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MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
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VA
VI
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WA
WI
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1/15/23 5-7 pm
Please fill out this form and click submit.
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