Family Entertainment Center Payment Authorization
Authorize payment for services and activities at our Family Entertainment Center. Please complete all required information to process your payment securely.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Guardian/Parent Full Name (if participant is under 18)
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Select Activities/Services to Authorize Payment For
*
Arcade Games
Bowling
Laser Tag
Birthday Party Package
Food & Beverage
Other
Amount to Authorize (USD)
*
The Last 4 Digits of Your Payment Card (for verification)
*
Signature of Cardholder/Guardian
*
Authorize Payment
Authorize Payment
Should be Empty: