2017 Birthday Party Reservation Form
Let us do all the work while you have all the fun! All inclusive party packages now available.
Name of Birthday Boy/Girl: _______________________________________________________ Age: _________
Parents Name: _______________________________________________________________________________
Address: ____________________________________________________________________________________
City: _________________________ State: ________________________ Zip Code: ______________________
Home Phone: _________________________________ Cell Phone: ___________________________________
E-Mail Address: ______________________________________________________________________________
Party Date—1st Choice: ____________________ 2nd Choice: _____________________
Party Time—1st Choice: ____________________ 2nd Choice: _____________________
How many children attending? Boys: _______________ Girls: _______________
No changes to the number of guests 48 business hours prior to the party! Full payment is due at the time of
booking. Please reserve your party a minimum of two weeks in advance to guarantee your preferred date.
Parties can be customized with different food options and combination party themes!
Please contact the Birthday Party Coordinator for more information.
Theme Party (Circle One)
Princess/Knight Cowboy/Cowgirl Jewelry Hawaiian Luau Pirate Classic
Theme Parties are two hours in length and accommodate 12 children (additional children may be included for a fee).
A craft, 2 pizzas, refreshments (2 Two Liters), tablecloths, plates, cups and a party host are included.
Fees: Residents $180
Non-Residents $ 215
($6 per child after 12 children)
Gym Party (Circle One) Basketball
Soccer
Kickball
Floor Hockey
Dodgeball
Obstacle Course
Gym Parties are two hours in length and accommodate 12 children (additional children may be included for a fee).
One hour in the gymnasium, one hour in the party room, 2 pizzas, refreshments (2 Two Liters),
tablecloths, plates, cups and a party host are included. For parties with 12 or less children, a 1/2 court will be reserved for use.
For parties with 13 or more children, a full court will be reserved for use.
Fees: Residents $180 Non-Residents $215
($6 per child after 12 children)
Indoor Swim Party
Swim Parties are two hours in length and accommodate 12 children (additional children may be included for a fee).
One hour in CORE Indoor Pool, one hour in the party room, 2 pizzas, refreshments (2 Two Liters),
tablecloths, plates, cups and a party host are included. (Please call for more info)
Fees: Residents $180 Non-Residents $215
($6 per child after 12 children)
Party Fee (Includes 12 children and 2 adults)
Additional Guests ($6 per person)
Extra Pizza ($18 per pizza)
Additional Soda (2 liter) ($3 Per Item)
Theme Parties of 12 or more guests—Add Party Host $24
Gym Parties of 20 or more guests—Add Party host $24
Other
Total Fee:
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Signature
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Date
For more information, please call Christine Aguirre at 630-257-6787 ext. 3002
BEHAVIOR MANAGEMENT POLICY
All participants are expected to exhibit appropriate behavior at all times. The following guidelines have been developed to help make programs safe and enjoyable for all participants. Additional rules may be developed for specific
programs as deemed necessary by staff.
The agency insists that all participants comply with a basic behavior code. All participants shall:
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Show respect to all participants, staff, and volunteers. Participants should follow program rules and take direction from staff.
Refrain from using abusive or foul language.
Refrain from threatening or causing bodily harm to self, other participants, or staff.
Show respect for equipment, supplies, and facilities.
The following infractions will constitute utilization of the discipline procedures.
1. Harming ones’ self such as, but not limited to:
a. Leaving grounds without permission.
b. Leaving designated group without permission.
c. Climbing on objects that are not recommended by staff.
d. Physical damage to self.
e. Possession, use or transfer of alcohol, illegal drugs, tobacco or tobacco products.
2. Harming others such as, but not limited to:
a. Fighting
b. Throwing objects at or near others.
c. Bringing or using weapons, i.e., knives, glass, sharp objects, etc.
d. Hitting, kicking or biting others.
e. Extreme verbal abuse.
f. Profanity
g. Showing disrespect to other participants and staff.
h. Other aggressive behavior including any verbal or physical bullying.
3. Damage to Property
a. Vandalism
b. Tantrums resulting in damage to property.
c. Breaking, damaging or destroying property.
4. Theft
a. Taking any item that does not belong to the child
LEMONT PARK DISTRICT’S WAIVER AND RELEASE
IMPORTANT INFORMATION
The Lemont Park District is committed to conducting its recreation programs in a safe manner and holds the safety of
participants in high regard. The Lemont Park District continually strives to reduce risks and insists that all participants
follow safety rules and instructions that are designed to protect the participants’ safety. However, Participants and parents /
guardians of minors registering for this program / activity must recognize that there is an inherent risk of injury when
choosing to participate in recreational activities.
You are solely responsible for determining if you or your minor child / ward are physically fit and / or skilled for the
activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any
way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.
WARNING OF RISK
Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of
serious injury when participating in any recreational activity / program. Understandably, not all hazards and dangers can be
foreseen. Participants must understand that certain risks, dangers and injuries due to acts of God, inclement weather,
slipping, falling, equipment failure, failure of supervision, premises defects and all other circumstances inherent to
recreational activities / programs exist. In this regard it must be recognized that it is impossible for the Lemont Park District
to guarantee absolute safety.
WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK
Please read this form carefully and be aware that signing up and participating in this program / activity, you will be expressly
assuming the risk and legal liability and waiving and releasing all claims for injuries, damage or loss which you or a minor
child / ward might sustain as a result of participating in any and all activities connected and associated with this program /
activity (including transportation services, when provided.).
I recognize and acknowledge that there are certain risks of physical injury to participants in this program / activity, and I
voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child /
ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child /
ward may have (or accrue to me or my child / ward) as a result of participating in this program / activity against the Lemont
Park District, including its officials, agents, volunteers and employees (hereinafter collectively referred as Lemont park
District.)
I do hereby fully release and forever discharge the Lemont Park District from any and all claims for injuries, damages, or
loss that my minor child / ward or I may have or which may accrue to me or my minor child / ward and arising out of,
connecting with, or in any way associated with this program / activity.
Registration will be accepted by mail, on-line or by fax. You may mail your form to the Lemont Park District 16028 127th
St. Lemont, IL 60439 or send by facsimile transmission to 630-257-6944. When registering by fax or on-line, it is mutually
understood that your on-line or facsimile signature shall substitute for and have the same legal effect as an original form
signature.
I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release
of all claims. If registering a minor participant, I further attest that I have read the above to my minor child/ward.
PLEASE PRINT ______________________________________________________
SIGNATURE OF PARENT ______________________________________________
DATE: ____________________