Your Information:

Parents Name, First and Last (required)

Your Email (required)

Best Phone Number:

Mailing Address:

Party Information:

Day of the Week:

Time:

Child's Name:

Child's Age:

Age Range of Participants:

Coach Preference:
---Coach DerekCoach MichelleCoach OrlandoOther

Sport(s):

Location:

Add Ons:
Zorb Balls $75.00 each
Arts and Crafts $100.00 per 20 kids
CDI to handle your Evites $100.00
Party favors (Priced to be set upon request)
Piñata’s $150.00

Please check all that apply:
Zorb Balls $75.00 eachArts and Crafts $100.00 per 20 kidsCDI to handle your Evites $100.00Party favors (Priced to be set upon request)Piñata’s $150.00

Please describe your event below:

*We will email you with total price, payment arrangements & details.

By hitting the submit button you agree to the follow Coach Derek's policy.

I, the undersigned participant, parent, or guardian, do hereby agree to participate and/or allow the individual(s) named herein to participate in the aforementioned activity(ies) and further agree to indemnify and hold harmless Coach Derek, Inc., its agents and employees from harm, accidents, personal injury or property damage which may be suffered by the aforementioned individual(s) arising out of, or in any way connected with the participation of the activity.