Teen Time Family Game Nights at the Virgin Islands Children's Museum
Group Visit Registration Form  * The Museum requires a minimum ratio of 1 adult to 5 children
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Organization Name
Contact Name
Contact E-Mail Address
Contact Phone Number
Emergency Contact Name
Emergency Contact Phone Number
# of Adolescents in the Group
Adolescent's Age Range
Name of the School(s) Adolescents Attend
# of Chaperones That Will Attend
Transportation Assistance Requested
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Dietary Restrictions of Youth and/or Chaperones
Other Information You Think We Should Be Aware Of
I am the authorized representative of the youth organization listed above, and I give my permission for the adolescent members of the organization listed above to attend Teen Time game nights at the Virgin Islands Children’s Museum located in Buccaneer Mall, Havensight, St Thomas. On behalf of said minors and their families, I hereby release VICM and its partners from any liability for illness, injury or medical expenses sustained by said minor while attending Teen Time at the VICM. I understand it is my responsibility as the authorized representative to arrange transportation to and from the museum for the Teen Time game nights.

In checking the box below, I grant my permission for the youth listed above to participate in this valuable educational experience. It also indicates that said youth can be photographed for grant reporting and promotional purposes.  
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