THE HOT SPOT Permission Slip!
In order for anyone under the age of 17 to use the services available at the hotspot, a parent or guardian must sign and personally deliver this form to The Hot Spot prior to any minor using the facilities.
I,______________________________, give permission for my child,
_____________________________ to use The Hot Spot up to _____ hours per week. My child may play games with the following ESRB rating(s) (Circle all that apply): E (everyone), T (teen), M (mature). My child may view movies with the following rating(s), (circle all that apply): G, PG, PG-13, R.
I have read and agree to the terms and conditions regarding the use of The Hot Spot.
_________________________________________
Name (Printed)
_________________________________________
Signed
___________
Date
1247 Central Avenue |
For office use only:
Date Received:
ID Verified:
CC#:
Name as appears on card:
Expiration:
Date of recordation:
Recorded by:
Our Address
1247 central ave suite d
Los Alamos, NM 87544
Store phone: 505 661-4005