Play Place FormPlease enable JavaScript in your browser to complete this form. – Step 1 of 5Your Name *FirstLastBusiness Name *Zip Code *Day and Time of Visit *I am visiting as a… *Caregiver (with children)Researcher (without children)NextKnow Before You GoCan caregivers accompany children into the play area?YesNoAre there restrictions on any of the following?HeightAgeClothing or jewelryOtherWhat are the restrictions?Are any of the following required?SocksWristbandsStamps on hand or wristOtherWhat else is required?What is the cost for each child and caregiver?Ask the staff: Is this a busy, slow, or average time? *Other Notes or Comments:NextSpace and Sensory ObservationsWhat types of play structures are present?Bouncy houseSlideJungle gymTrampolineBall or foam pitLadder or rope ladderSuspension bridgeMerry-go-roundBasketball hoop or courtStackable blocksTactile cubes or stationsOtherDescribe additional equipment.Is there spinning, rocking, or moving equipment?YesNoWhich structures, and how do they move?Do any of the structures require a caregiver's assistance?YesNoWhich structures, and what kind of help is required?Does the play area have any of the following?Linoleum or hard floorsCarpeted floorsTurf or grass areasGlass walls or large windowsThick mats on walls or floorsDoes the play area have any of the following?Sharp corners or edgesSlippery or unstable surfacesUneven floorsSteep stairsGaps between structuresParticularly low or high ceilingsDescribe and note anything you feel is dangerous.Is there a dedicated space for infants and toddlers?YesNoIs it in another room or removed from the main play area?YesNoIs there a calming space or quiet area?YesNoIs it a dedicated calming space?YesNo, but it works in a pinchDescribe the space, how to access it, and how effectively it blocks out light, sound, and other children.How would you describe the lighting in the play area?Very brightSomewhat brightAverageSomewhat dimVery dimWhat kinds of visual stimuli are noticeable?Moving or spinning objectsBlinking or moving lightsVery bright or harsh lightBlacklightVery bright or fluorescent colorsStimulating posters or artworkDescribe other visual stimuli or observations.How would you describe the volume in the play area?Very loudSomewhat loudAverageSomewhat quietVery quietDecibel range (using Decibel X app):What kinds of sounds are noticeable?Machine or equipment noisesMusic, radio, or PA announcementsEchoes from the play area or other roomsExternal noises, such as traffic or constructionDescribe other noticeable sounds or observations.What kinds of smells are noticeable?Cleaning productsAir freshenersFood or cooking smellsDescribe other noticeable smells or observations.Are there small or loose objects that could be chewed or swallowed?YesNoDo any areas seem particularly hot or cold?YesNoWhich areas?Does the space seem crowded?YesNoApproximately how many children are in the space?Restrooms and General ObservationsAre there multiple restrooms or stalls for each gender?YesNoAre the restrooms easily accessible from every area?YesNoDo the restrooms have any of the following?Hand dryersPaper towelsAir freshenersStrong cleaning smellsDiaper changing stationStools to help reach sinks or toiletsAre there drinking fountains or water coolers?YesNoAre they easily accessible from every area?YesNoDoes the space seem generally clean and safe?YesNoDoes the staff seem helpful and attentive?YesNoOther Notes or Comments:NextParties and AmenitiesAre you attending for a party or private event?YesNoDoes your party have any of the following?Access any play area at any timeExclusive access to some or all play areasControl over the light levels in the party roomControl over the music or PA volume in the party roomIs there food available for purchase?YesNoWhich of the following are available?Packaged snacks and drinksUnpackaged snacks, such as ice creamSmall meals, such as hot dogs or pizzaHealthy options, such as fruit, yogurt, or hummusNut, dairy, or gluten free itemsCoffee or other hot beveragesCan the food be easily accessed or grabbed by children?YesNoIs there a place apart from the play area for caregivers to sit?YesNoAre any of the following included?Tables or countersOutletsWi-fiTelevisionDimmer or less harsh lightQuieter music or noise barrierOther Notes or Comments:NextPost Visit AssessmentHow long did you spend at this play place? Why did you leave?How did you feel when you left? Why do you think that is?If you brought children, how did they feel when they left? Why do you think that is?What does this play do well?What could this place do better?What kind of child would enjoy this place?How would you describe this place to another parent or caregiver?Did you have a special request? What was it, and was the staff accommodating?Attach a photo of the manager's business card.EmailSubmit Share Share Tweet Pinterest Email
