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Cricket Empowerment Company
Birthday Event Form
Contact name
Surname
Email
Child's Name
contact number
Age of Child
Birthday Party
Package
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Choose a Package
Date of Birth
Desired Party Date
Approx. No of Guests
Additional Requirements or Comments
How Did You Hear About Us?
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I the parent or legal guardian would like to provide another entity or individual limited consent to obtain medical care for my child. I, the parent/guardian grant permission to Cricket Empowerment Company for the use of the photograph(s) or electronic media images as identified below in any presentation of any and all kind whatsoever. I understand that I may revoke this authorization at any time by notifying Cricket Empowerment Company in writing within 7 days of camp ending. The revocation will not affect any actions taken before the receipt of this written notification.
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