(check all that apply and give age ranges as your facility groups them)
Number of Infants
Age Range: mos.
to mos.
Number of Toddlers
Age Range: mos.
to mos.
Number of Preschoolers
Age Range: yrs.
to yrs.
Number of School-Agers
Age Range: yrs.
to yrs.
Is handicapped accessibility needed?
Level of disability
(Note: Church affiliated childcare and schools and playgrounds with less than 1,000 square feet are the only exemptions to the Americans with Disabilities Act.)
Existing Playground Conditions:
Please show on plan and check off list. Please write clearly and double check all measurements for accuracy. Indicate North compass direction on plan.
Measure perimeter of area and show dimensions of all sides, fences and gates. Show widths
of gates and direction in which they open. Indicate perimeter fence height.
Measure location of all play equipment, structures, walks, and trees. Show locations on plan.
Show doorways and windows facing or opening into playground area.