Escape Room Registration

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Registration Information

Name (Adult)*

Phone Number*

Email Address*

Player Information

Player Name*

Date of Birth*

Address*

City*

State*

Zip Code*

If you belong to a synagogue, please let us know the name and location. (Optional)

Registration Information

Team Leader (Adult)*

Phone Number*

Email Address*

How many teams are you registering?*

Team/Class Information

For each team, please submit a team name and the number of players on the team.*

What's the average age of all the players?*

Address*

City*

State*

Zip Code*

How did you hear about the Escape Room? *

$ Donation Amount:

Select Payment Method

Personal Info

First Name *

Last Name

Email Address *

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $20.00