Reservation Form

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Reservation Form

Email *

Name *

Phone Number *

Reservation Date *

RESERVATIONS START AT 2pm and last session is at 1am

YYYY

Time

Group Size *

Which Session are you interested in? *

Regular Session $35 per person - 30 mins

Mad Man $45 per person - 45 mins

Couples Therapy $60 - 30 mins (2 person package)

2 x 1 Regular Rage (TUESDAY SPECIAL)

Groups (10 or more) email reservations@themadhouserageroom.com

Required

Are all guests 18 and over *

Yes

If under 18, list ages (if above 18, answer “NA”) *

I understand I need to submit my deposit to hold my session time. This deposit in non refundable and will be applied to my total once session is complete. *

Yes

I understand that if I am more than 10 mins late to my session time, I have now forfeited my session time and deposit. To reschedule you need to call us in 2 hours in advance before your session time. *

Yes

DON'T FORGET TO SUBMIT THIS FORM!!!!

The deposit link below will redirect you so make sure you come back and submit this form

Reminder no open toed shoes and shorts!!

A copy of your responses will be emailed to the address you provided.

Submit

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