Email Captain Kid & Parrot Jax
Your Name *

First
Last
Is the Celebration for a Person?

First
Last
Age Range of Guests:
With Whom Do You Wish to Celebrate?
 Pirate/Magician Capt. Kid  
 Magician "KC" Cameron 
 DJ "KC" Cameron 
 Parrot Jax 
What is the Date and Time the Excitement Begins?

MM		/
DD		/
YYYY
HH		:
MM
AM/PM
Length of Excitement?
Will This Be Outside?
 Yes 
 No 
Location of Celebration?

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Type of Celebration?
(check all that apply)
 Wedding 
 Birthday 
 Mitzvah 
 Quinceanera 
 Grand Opening 
 Resturant 
 Holliday 
 Summer 
 Fair 
 Other 
Entertainment Type?
(check all that apply)
 Living Room Show 
 Party Games for Adults 
 Comedy Hypnotism Show 
 Stage Magic 
 Parlor Magic Show 
 Living Room Show 
 Close-up Magic 
 Strolling Magic 
 Street Magic 
 Bed-of-Nails 
 Fire Eating/Breathing 
 Fire Walk 
 Glass Walk 
 Balloons 
 Parrot Jax 
 Other 
Name of Organization Celebrating?
(check all that apply)
Organization Celebrating?
(Check all that apply)
 Private 
 Corporate 
 School/College 
 Religious 
 Goverment 
 Non-Profit 
 Other 
Email *
Confirm Email *
Phone Number

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Message for KC:
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