Party Request Form - Greenville Gemstone Mine

Birthday Section

Disclaimer – Please Be Sure To Review Our Birthday Party Payment And Cancellation Policy Before Completing This Form.

Name of Contact Person*

First Last

Relationship to child*

Birthday Child Name*

First Last

Age Child is Turning*

Child 2 Favorite Colors*

Contact Information

Address

Street Address Address Line 2 City State ZIP Code

Email*

Contact Phone*

Billing Address

Street Address Address Line 2 City State ZIP Code

Package Type

Choose a Location*

CRGM Birthday Party Add Ons

T-shirt for All Kids (10.00 Per T-shirt)

Youth Small

Youth Medium

Youth Large

Adult Small

Balloons & Decorations ($50.00)

1 Dozen Balloons and Streamers, Plates, Cups & Napkins

Cupcakes

1 Dozen ($20.00)
2 Dozen ($40.00)
None

Assorted Juices

1 Dozen Assorted Juices ($15.00)
2 Dozen Assorted Juices ($30.00)
None

Assorted Sodas

1 Dozen Assorted Sodas ($15.00)
2 Dozen Assorted Sodas ($30.00)
None

Extras

Add An Extra Bucket & Treat Bag $12.00

Food and Drink you will be bringing:*

Type of Decorations you will be bringing:*

Special Instructions or Needs

(We will do our best to accommodate any special requests or needs your party may have)

Date Information

What Date and Time would you like to request?
(Please list your top 3 choices)

Date Option 1*

Date Option 2*

Date Option 3*

Party Time Preference?*

: HH

MM

Review & Confirm

Please review the Birthday Party Payment And Cancellation Policy before proceeding.

Do you agree with the above-mentioned policies.*

I agree

Name

This field is for validation purposes and should be left unchanged.