_______ (address) Block Party / _____ (date)ADDRESS/PHONE#: ________________________________ ADULT SPONSOR: _________________________________

WRISTBAND ORDER FORM

ONE HOUR OF VOLUNTEER TIME IS REQUIRED (please circle your preferred shift): Between 11:00 and 2:00 Between 2:00 and 5:00 Between 5:00 and 8:00

CHILDRENS NAMES: _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________

(additional names can be listed on the back)

TOTAL WRISTBANDS: ______ X $5.00 each = $ ______________Please turn in completed form with money to _____ (names with addresses) by _______ (date).ANY CHILD (ages 2-17) WHO WOULD LIKE TO PARTICIPATE IN THE SCHEDULED ACTIVITIES MUST HAVE A WRISTBAND AND AN ADULT SPONSOR WHO IS A RESIDENT OF ______ (block) AND THE SPONSOR MUST BE PRESENT THE DAY OF THE BLOCK PARTY. WRISTBANDS PURCHASED ON THE DAY OF THE BLOCK PARTY WILL COST $10.00 _______ (block) residents will not be responsible for any injuries that may occur to anyone participating in any of the block party events.