Impact Teens Laser Tag Registration 2022 • Impact Church Worldwide

Event Date: Friday, September 16, 2022

Start & End Time: 7:00pm- 10:00pm

Location:

Bullseye Laser Tag

200 Menlo Dr. (Located in: Menlo Park Mall)

Edison, NJ 08837

Registration Require

Registration Ends: Friday September 9th, 2022 @ 8pm

ONLY 28 SPOTS AVAILABLE!!!

registration costs: $25.00

Who will be attending this event? *

Teen

Parent/Guardian

Teen's First Name

Teen's Last Name

Age

Grade

Teen's Email Address

Teen's Mobile Number

First time joining Impact Teens

Yes

Parent's/Guardian's Full Name

Parent's/Guardian's Mobile Number

Parent's/Guardian's Email Address

Parent's/Guardian's Consent:

Emergency Contact's Name *

Emergency Contact's Number *