Youth Gardening Registration
Register your child for our nonprofit youth gardening sessions. Please complete all sections.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Child's Full Name
*
First Name
Last Name
Child's Age
*
Child's Grade
*
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Child's School Name
*
Medical or Allergy Information (please specify any medical conditions, allergies, or medications)
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Session Days/Times
*
Second Saturday, 12 p.m.
Other (please specify below)
If you selected 'Other', please specify your preferred days/times
Do you give permission for your child to participate in the youth gardening program?
*
Yes, I give permission
No, I do not give permission
Do you consent to your child's photo or media being used for nonprofit promotional purposes?
*
Yes, I consent
No, I do not consent
Parent/Guardian Signature
*
Submit Registration
Submit Registration
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