Visitor Form

Child's Full Name

Child's Primary Address

Child's DOB

Child's School

Parent/Guardian's Full Nam

Relationship to Child

Phone Number(s)

Parent's E-mail Address

When would you like to schedule a free visit? Adventure Play is open afterschool Monday-Thursday from 3:30 – 5:30 p.m.

Emergency Contact Name - n the event you cannot be reached, you give this person permission to pick up your child.

Driver's License Number and State

Phone Number

Relationship to Child

Please outline any medical needs your child has, such as allergies, medical condition, medications and dietary restrictions:

In the event that I/we cannot be reached to make arrangements for emergency medical attention, I/we authorize a designated Parish School staff member to contact EMS to take our child to the nearest hospital. * By clicking the button, you are effectively providing your signature, indicating that you have read and understand the above information. In the event that I/we cannot be reached to make arrangements for emergency medical attention, I/we authorize a designated Parish School staff member to contact EMS to take our child to the nearest hospital. * By clicking the button, you are effectively providing your signature, indicating that you have read and understand the above information. In the event that I/we cannot be reached to make arrangements for emergency medical attention, I/we authorize a designated Parish School staff member to contact EMS to take our child to the nearest hospital. * By clicking the button, you are effectively providing your signature, indicating that you have read and understand the above information. We give our consent for any and all necessary treatment.