Visitor Form

Schedule your free, 2-day visit!

Complete the following form to schedule a visit.

Child's Full Name *

Child's Primary Address *

Child's DOB *

Child's School *

Parent/Guardian's Full Name *

Relationship to Child *

Parent's E-mail Address *

Phone Number(s) *

When would you like to schedule a free visit? Adventure Play is open afterschool Monday-Thursday from 3:15 – 5:30 p.m.

Emergency Contact

Contact Name * In 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 *

Medical History and Consent

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.

We give our consent for any and all necessary treatment.

Adventure Play Thank You

Visitor Form

Educating children ages 2-12 who have communication delays and learning differences.