Siletz Community Garden Registration
Name
*
First Name
Last Name
Email
*
example@example.com
Date of Birth
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Roll Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Information
Emergency Contact Name
Relationship
Phone Number
Gardening Details
Preferred Class Days/Times: If events around gardening and/or volunteering we're being held...
Gardening Experience
Beginner
Intermediate
Advanced
Which days of the week would work best for you?
Monday
Tuesday
Wednesday
Thursday
What time works best for you?
Early Morning (6am-8am)
Morning (8am-12pm)
Early Afternoon (12-4pm)
Evening (4-8pm)
Health Information
Do you have any existing medical conditions or injuries you would like staff to be aware of?
Allergies (if any)?
Do you have any specific health goals for gardening?
Submit
Should be Empty: