Birthday Request Form

Thank you for your interest in the Anita C. Leight Estuary Center for your birthday party experience. Please give us the following information so that we can best design a program for you.

Birthday Child's Name & Age

Name of Group Contact

Group Contact Phone Number

Phone: (emergency/cancellation)

Group Contact Email

Preferred Date

Preferred Time Block (start to finish)

Preferred Date 2

Preferred Time Block 2 (start to finish)

Preferred Date 3

Preferred Time Block 3 (start to finish)

Total Number of Guests (max 50)

# of Children(up to 20, age 3-16)

# of Adults

Birthday Party Theme(see below for descriptions)

Pricing (choose one)

If you have any questions, please call the Estuary Center at 410-612-1688 or email at aclec@harfordcountymd.gov