Visit a real 4th Generation working farm that provides a variety of educational farm experiences that are hands on for families,
and SCHOOLS! Providing farm education for over 23 years.... Meet Mr. Benton who came here in 1941 at ten yrs old.
"Adventure Days on the Farm"
11896 Old Lexington Pike Walton, KY 41094
859-485-7000 cell 859-240-4552
Email us and tell us what dates you might be interested in first! We may be booked.
Does your child love the outdoors, animals, dirt, and having fun?
Session# 1 July 8-12 ____ Session # 2 JULY 15-19 ___
Session #3 pending please call July 22-26___
Child’s Name ________________________________________Age_______
City______________________ State____ County____
Zip__________ Home/main cell phone#_______________________
Name of School__________________________
LAST Grade COMPLETED:________
Child resides with Mother and Father__
OR Mother ___Father____
($60.00 due with application NO REFUNDS)
(remainder due first day on Monday)
cell# ________________ Mother
Alternate Emergency contact
Name________________________________________ # _____________________________
Alternate Emergency contact
Name_________________________________________ # ______________________________
In case of emergency, we will call the above phone numbers
Does the child have any allergies, special needs, asthma, or any other restrictions? ___yes ___no Explain
Family Dr Name______________________________________ #_____________
Benton Family Farm 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 or food allergies.
Make checks Payable to BENTON FAMILY FARM 11896 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 if so needed.
I understand that photos of Adventure Days may be taken during the week and may be used on website/face book in farm advertising and our publications.
Does child medical insurance? Y/N Name___________________ #___________________________ Signature of parent/guardian_________________________________ Date____________ Signature of parent/guardian__________________________________ Date____________ T shirt size Circle one _______Child small, med, large, x large OR Adult small, med, large, x large,
Does child medical insurance? Y/N Name___________________
Signature of parent/guardian_________________________________ Date____________
Signature of parent/guardian__________________________________ Date____________
T shirt size Circle one _______Child small, med, large, x large
Adult small, med, large, x large,
Remember they bring their lunch and a water bottle!