Rose & Grace Mini Farm
13625/13627 FM 2769 (Volente Rd) Austin, TX 78726

Name of Student __________________________________
City: _________________ State: _________ Zip: __________
Mother’s Name: ___________________ Home Ph: ____________ Cell Ph: __________
Father’s Name: ____________________ Home Ph: ____________ Cell Ph: __________
Contact in case of emergency: _______________________________________________
Date of Birth: ___________
Address: __________________________________________ Email: _______________Medical Concerns: ________________________________________________________________________________________________________________________________
Allergies: _______________________________________________________________


​Please attach photo of attending child
What to Bring:
-Comfortable outdoor clothes
-Swimsuit under clothing
-Towel
-Tennis Shoes/Boots (I recommend water shoes for some creek exploring)
-Sack Lunch
-Water Bottle