Your Name (Parent) Catherine Bruckner Email catherine.gertner@gmail.com Cell Phone (917) 855-4252 Your Address 124 E 70th Street New York, New York 10021 United States Birthday Child's Name Joachim Birthday Child's Age (turning) 3 Day & Time of Party October 4th Location of Party Central Park - lawn north of Michael James Levin Playground Do you have a permit? No Are you planning on getting a permit? No Number of kids attending the party 15 Is your child currently a SocRoc student? Yes