Placemat Request

Placemat Selection:  Please Select One 1st Birthday Bear & Baby Bear Popping out of Box Cowboy Dragon Faries Pink Bear with Gift Pirate Cat Purple Balloons & Gifts Squirrel Tiger

Number in Party:  Please Select 6 7 8 9 10 11 12 13 14 15

Where Party is to be held  - SuperMall Location

Date of Birthday Party: 

Parent's Name: 

Birthday Age: 

Child's Name as to appear on Placemat: 

Email Address: 

Remember to send Photo in JPEG to info@kidsatthemall.com