Online Player Waiver Please fill in the information below: Your First Name * Your Last Name * Note: below you will be able to add names of your children to this waiver Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Your date of birth * (mm/dd/yyyy) Email Address * Choose the location that you are attending Gaithersburg Springfield/Alexandria If you are attending a party/event, please enter the outing information: Birthday Child’s name or Group Event name Party/Event Code (if you were given a code by the person organizing the party or outing please enter it here) Event Date Event Time Laser Tag 10:30am 11:45am 12:00noon 1:00pm 2:00pm 2:15pm 2:30pm 3:30pm 4:45pm 5:00pm 6:00pm 7:15pm 7:30pm 8:30pm Other Glow Golf 12:00noon 12:30pm 2:30pm 3:00pm 5:00pm 5:30pm 7:30pm 8:00pm Other Add Child to Waiver First Name * Last Name * Birth Date * (mm/dd/yyyy)