Play day at the Billings farm

Enter the information below for the children that will be spending the day at the Billings Farm. During the day the children will spend time outside (weather permitting), have a quiet time, do crafts, play games, watch a family friendly movie and have time to play. There is room to enter up to six kids. It is NOT necessary to complete the waiver that appears at the bottom of the page.

Parent or Gaurdian Details

Parent/Guardian Name *

First

Last

Email *

Phone *

Parent or Guardian Photo *

Drag & Drop Files, Choose Files to Upload

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Child 1 Details

Name

First

Last

Date of Birth

Gender

Female
Male

Is Child 1 Potty Trained?

Yes (Please provide extra clothing just in case)
No (Please provide diapers and supplies)

If Child 1 is potty trained, how often do they need to be reminded to go potty?

Every minute of the live long day.
once an hour
every couple of hours
He/She will tell you

This child has permission to participate in these activities:

Jumpy Thing
Barn Swing
Slide
Cow Train

We won't always do any of these activities, but it is possible.

Please let us know about any behavioral concerns:

Please let us know about any medical concerns:

Please let us know about any allergies:

Child 2 Details

Name

First

Last

Date of Birth

Gender

Female
Male

Is Child 2 Potty Trained?

Yes (Please provide extra clothing just in case)
No (Please provide diapers and supplies)

If Child 2 is potty trained, how often do they need to be reminded to go potty?

Every minute of the live long day.
once an hour
every couple of hours
He/She will tell you

This child has permission to participate in these activities:

Jumpy Thing
Barn Swing
Slide
Cow Train

We won't always do any of these activities, but it is possible.

Please let us know about any behavioral concerns:

Please let us know about any medical concerns:

Please let us know about any allergies:

Child 3 Details

Name

First

Last

Date of Birth

Gender

Female
Male

This child has permission to participate in these activities:

Jumpy Thing
Barn Swing
Slide
Cow Train

We won't always do any of these activities, but it is possible.

Please let us know about any behavioral concerns:

Please let us know about any medical concerns:

Please let us know about any allergies:

Child 4 Details

Name

First

Last

Date of Birth

Gender

Female
Male

This child has permission to participate in these activities:

Jumpy Thing
Barn Swing
Slide
Cow Train

We won't always do any of these activities, but it is possible.

Please let us know about any behavioral concerns:

Please let us know about any medical concerns:

Please let us know about any allergies:

Child 5 Details

Name

First

Last

Date of Birth

Gender

Female
Male

This child has permission to participate in these activities:

Jumpy Thing
Barn Swing
Slide
Cow Train

We won't always do any of these activities, but it is possible.

about of any

Please let us know about any behavioral concerns:

Please let us know about any medical concerns:

Please let us know about any allergies:

Child 6 Details

Name

First

Last

Date of Birth

Gender

Female
Male

This child has permission to participate in these activities:

Jumpy Thing
Barn Swing
Slide
Cow Train

We won't always do any of these activities, but it is possible.

Please let us know about any behavioral concerns:

Please let us know about any medical concerns:

Please let us know about any allergies: (copy)

Children's Doctor's Name

First

Last

Children's Doctor's Phone

Is anyone besides you allowed to pick up your children??

No
Yes

Please list who can pick up your children:

Photos of those allowed to pick up your children:

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Parent/Guardian Signature *

Clear Signature

Name *

First

Last

January 24, 2026 Play Day At The Billings Farm

Parent or Gaurdian Details

Child 1 Details

Child 2 Details

Child 3 Details

Child 4 Details

Child 5 Details

Child 6 Details