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2. JCPRD Logo
   
4. Full Name*
5. Email
6. Phone Number*
   Please enter phone number in format shown.
8. Create An Online Account
   Create an Online Account Here

   Please click on the registration link above to create an online account with JCPRD. This protects your sensitive personal information. If you already have an account with JCPRD, please take a moment to verify the information in our new system is correct. This will allow you to view contracts and make payments online.
10. Birthday Child's Name*
11. Age Birthday Child is turning*
13. Date Requesting For Birthday Party*
    Date Requesting For Birthday Party
    Please fill in the preferred Saturday for the birthday party you are requesting. No Parties available on April 24th, 2021 due to our Annual Open House Event.
14. Preferred Party Time*

    1. 10:00 am - 12:00 pm, with program from 10:15 - 11:00 am
    2. 12:00 pm - 2:00 pm, with program from 12:15 - 1:00 pm
    3. 2:00 pm - 4:00 pm, with program from 2:15 - 3:00 pm
    4. Zip Line/Climbing Tower party times vary depending upon availability - 3 1/2 hour party
15. Number of Kids Participating*
    If you have more than 15 kids for archery or bb gun parties, there is an additional fee of $4/kid upto 25 participants.
16. Number of Non-Participating People Attending
    Please list additional people attending the party but not participating in the activity.
18. Type of Birthday Party Requesting*

    1. Archery Party (15 guests) $139.00
    2. BB Gun Party (15 guests) $139.00
    3. Boating Party (10 boats, canoes of pedal boats only) $159.00
    4. Fishing Party (15 guests) $139.00
    5. Climbing or Zipline Party (20 guests) $300.00
19. How did you hear about our birthday parties? *

    1. TimberRidge Website
    2. Johnson County Park and Recreation Website
    3. Friend or Family Referral
    4. Facebook - TImberRidge Page
21. Notes:
    Add any additional information you have about your event here.
23. Staff Responding to Email
24. Date Contract Sent
    Date Contract Sent

    Date Contract Sent
25. Date Payment Made
    Date Payment Made

    Date Payment Made
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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