Eureka After School D&D Registration & Release Form
This document must be submitted (either through Google Form or printed and returned through email) before your child can participate. 
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After School D&D will be held at Boston Workers Circle (6 Webster St, Brookline, MA 02446) from 4:00-6:00pm (times may vary slightly), on Tuesdays, Wednesdays and Thursdays. 

Please remember players must bring with them each week their character sheet, dice, and a water bottle. They may also bring a copy of the D&D Player's Handbook.
Campaign Day
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Name of Child
Birth Date
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Age
Grade
Name of School
Gender
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Pronouns
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Address
Child's Cell Phone Number (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?
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! Puzzles & Games After School Dungeons and Dragons program. (Please type your full name acknowledging consent and accuracy of the information entered above).
We look forward to adventuring with your child through the magical and fantastical world of tabletop role playing games!
If you have any questions or concerns, or need to share any additional information, please reach out to us at info@eurekapuzzles.com or (617) 738-7352! Thank you!
Eureka! Puzzles (617) 738-7352 info@eurekapuzzles.com 1355 Beacon St, Brookline, MA 02446
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