Welcome to BENTON FARMS
Visit a real working farm that provides a variety of educational farm experiences for families, schools, daycares, day camp, birthdays, only here in Walton, Ky.
Farm Adventure Day Camp
Benton Farms Adventure Days 2009 Registration Form
11946 Old Lexington Pike Walton, KY 41094 859-485-7000 cell 859-240-4552
Session # 1 June 8-12____ Session # 2 June 15-19_____
Child’s Name ____________________________________________Age___ DOB____/____/_____ Gender_____
Home address__________________________________________________________________________________
City________________ State____ County________ Zip__________ Home phone#___________________________
Email: ________________________________________
Name of School__________________________ ___________Grade:________
Hobbies/clubs: _____________________________________________________________________________________
Mother’s Name ____________________________ Father’s Name_________________________
Home#________________________________ Home#_______________________________
Work#_________________________________ Work #_______________________________
Cell #__________________________________ Cell #________________________________
Child resides with __Mother and Father __Mother __Father __Other ____
In case of emergency, we will call the above phone numbers (Please list another alternate)
Name______________________________________ Home# ___________________cell#___________
Family Physician Name: ________________________Phone#__________________________________
Does the child have any allergies, special needs, asthma, or any other restrictions?
___yes ___no
(Explain)___________________________________________________________________________________________
Benton Farms reserves the right to refuse registration for health reasons, as the farm environment may not be suitable for children with severe hay, bee, wheat and food allergies.
FEES: Session # 1, 2, 9:30-3:00 pm $150.00____ ($50.00 due with application) (remainder due first day)
Make checks Payable to BENTON FARMS 11946 Old Lexington Pike Walton, KY 41094
We will contact you with a confirmation letter, information packet and instructions for Farm Adventure Days.
I the Parent/Guardian of_________________________ give permission for my child to receive emergency medical care, I understand that photos of adventure days may be taken during the week and be used in farm advertising and publications.
Signature of parent/guardian________________________________________ Date____________
