Pascuales Farm Chicken CSA

Pascuales Farm Chicken CSA

Healthy Chicken Club Sign-Up Form
Customer Details:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Section 2 – Membership Commitment I would like to join the Pascuales Farm Chicken CSA for:

3 months6 months12 months
I understand this program requires a commitment to purchase 1 whole chicken per month

YesNo
Preferred chicken size:

4–5 lbs.6–7 lbsNo preference
I understand that pickup is once per month at Pascuales Farm. Preferred pickup time window:

Morning (9am–12pm)Afternoon (12pm–4pm)Evening (4pm–7pm)
How did you hear about the Healthy Chicken Club?
Would you like to receive farm updates, recipes, and event invitations?

YesNO
Agreement I understand that chickens average 4–7 lbs. at $6.00 per pound, for an estimated monthly cost of $24–$42.

Yes
Agreement: I understand that this is a farm product, and the exact weight may vary slightly each month

Yes
What does CSA mean?

CSA stands for Community Supported Agriculture — a model where families commit to buying directly from a farm, allowing farmers to plan responsibly while providing members with high-quality local food.

At Pascuales Farm, we call it the Healthy Chicken Club because it’s simple, friendly, and built of trust.
Do you have any questions or comments for the farm?
Signature

Powered by Jotform SignClear
Should be Empty: