Community Roots: We Grow Together

We have an exciting opportunity to bring our faith to life and tangibly serve our community. With our new "Community Roots" initiative, we are transforming unused church land into a thriving community farm, and we need your help to make it happen.

Our mission is to cultivate fresh, healthy produce for low-income families and seniors in our neighborhood. But this project is more than just food—it's about connection, learning, and growing together.

Name

First NameLast Name

Age (Required for program statistics)

Gender (Required for program statistics)

Other

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Relationship

How do you learn about this online class?

Waiver and Release: We, the Participant or Guardian, Release and forever discharge and hold harmless Community Roots or its' parent organization, Youth for Global Health and Social Justice (Y4GH), and its successors and assigns from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from the activities as a participant with the Community Roots. We understand and acknowledge that this Release Discharges Community Roots from any liability or claim that we may have against Community Roots with respect to bodily injury, personal injury, illness, death, or property damage that may result from the Participant’s involvement in the Community Roots activities.

Photographic Release: We, the Participant or Guardian, grant and convey to Community Roots all right, title, and interest in any and all photographs, images, video, or audio recordings of the Participant or his or her likeness or voice made by Community Roots in connection with the Participant’s involvement in Community Roots events, including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recordings.

Medical Treatment: We, the Participant or Guardian, hereby Release and forever discharge Community Roots from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered in connection with an emergency during the Participant’s activity with the Nonprofit. We give our consent for the Nonprofit to provide, administer, or obtain medical treatment for the Participant.

Other: We, the Participant or the Guardian, expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Michigan and that this Release shall be governed by and interpreted in accordance with the laws of the State of Michigan. We agree that in the event that any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.

By signing below, I, the Participant or Guardian of the above named Participant, express my understanding and intent to enter into this Release and Waiver of Liability knowingly and voluntarily.

Parent/Guardian Name

First NameLast Name

Signature

Date Signed

Date

Community Roots Online Class Registration Form

Student Information

Parent/Guardian Information (Required for students under the age of 18)

Miscellaneous

Participant Release and Waiver of Liability