Tuesday, June 7th

6:00 PM – 8:00 PM
$15.00
PowerPlay Family Entertainment Center is an 80,000-square-foot, state-of-the-art fun
center with something for everyone. Enjoy the very best attractions at the premiere
place for family fun in Kansas City. The exciting facility includes go-karts, laser tag,
cosmic golf, bumper cars, tilt-a-whirl, swing and rascal rocket rides and a kids zone
area. $15.00 covers incredible buffet, and $20.00 in points on a PowerCard which can
be used for games and/or attractions.

Please make check payable to Prince of Peace and return with the form by June 5th.
We will meet at the center which is located at 13110 W. 62nd Terrace, Shawnee, KS.

Please contact Phyllis Mills at PMills@PrinceofPeace.info if you are interested in

attending so that we can ensure we have enough chaperones.
-------------------- -----------------------------------------------------
Please print all information:

Student’s Name: _________________________________________ Grade: __________

Student’s Cell Phone #: _________________________________________________

Parent’s Name: _________________________________________________________

Emergency Contact Number: ______________________________________

I/We, the parent(s) of: _______________________________________________

request that our child be allowed to participate in this activity. I understand that this event will take
place away from the church grounds. I, hereby give my permission for his/her participation. I hereby
release and save harmless Prince of Peace Church and any or all employees and volunteers from
any or all liability for any injury resulting from this event.
________________________________________________
Parent’s Signature

__________________________________________________________
Date