Eureka! Game Vacation Days!
This document must be submitted (either through Google Form or printed and returned through email) before your child can participate. 

Thank you for your understanding and help keeping our participants safe & accounted for!
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Eureka's Game Vacation Days will be held at Knight Moves Café located down the street from our storefront at 1402 Beacon St, Brookline, MA from 10am to 4pm.

PLEASE NOTE: These game days are for ages 10-15; we cannot accept children who are younger than 10 into the program.

Participants should pack a water bottle and lunch; a morning snack will be provided, and counter snacks (chips, candy, brownies) can be purchased at the café in addition to the provided food. Participants can also purchase food during the lunch break from restaurants/stores in the Coolidge Corner area with a guardian's permission as indicated on this form. 

If you have any questions/concerns please reach out to us at info@eurekapuzzles.com or by phone at 617-738-7352. 
Program Days - February
Name of Child
Birthdate
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Age
Grade
Gender
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Pronouns
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Address
Child's Cell Phone # (If Applicable)
Name of Guardian
Guardian's Cell Phone Number
Guardian's Email
Please Provide an Alternative Contact If Parent/Guardian is Not Available In An Emergency (Name + Cell Phone #)
Contact's Relationship to Child:
Child's Doctor (Name + Phone #)
Any Disability or Recurring Illness?
Allergies or Dietary Restrictions?
Specific Activities to be Limited?
Current Medication or Medical Treatment?
Anything Else Staff Should Be Aware Of?
Will Your Child Arrive On Their Own, Or Will They Be Dropped Off?
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If Applicable, Please Specify Who Will Be Dropping Your Child Off (Name and Cell Phone #)
Is It Okay For Your Child to Go Home Alone?
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Is It Okay For Your Child To Go Home With Another Person?
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If Yes, Whom? (Name + Relationship + Cell #)
PARENT/GUARDIAN EMERGENCY MEDICAL TREATMENT APPROVAL: In the event I cannot be reached, I give permission to medical personnel to order X-rays, routine tests and treatment for my child. If I cannot be reached, I give permission for a qualified physician to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for my child.
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HOLD HARMLESS:  I understand that my child’s participation in youth events can expose them to dangers both from known and unanticipated risks. Acknowledging that such risks exist, I hereby release and discharge Eureka Puzzles, Inc. & its officers, agents, employees, as well as the owners, operators, and employees at the venue for this program for any inadvertent negligence that might arise during the after school program.
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PROGRAM DOCUMENTATION:  I understand that from time to time, Eureka may be taking photographs of the room, layout, and participants for documentation, training, and marketing purposes. 
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I hereby confirm that all of the above information is correct to the best of my knowledge and I consent to having my child participate in Eureka! Game Vacation Program. (Please type your full name acknowledging consent and accuracy of the information entered above).
We look forward to exploring games (old and new) with your child to find some favorites and make some friends!
If you have any questions or concerns, or need to share any additional information, please reach out to info@eurekapuzzles.com. You can also reach us at 617-738-7352. Thank you!
Eureka! Puzzles (617) 738-7352 info@eurekapuzzles.com 1355 Beacon St, Brookline, MA 02446
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