Community Garden Plot Registration 25-26

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Preferred method of communication:

PhoneEmail

Choose location

100 NE44th Street, Deerfield Beach, FL 330641089 NW 6th Avenue, Pompano Beach, FL 330601201 W Dania Beach Blvd, Dania Beach, FL 33004

Payment options-

CashCheckCredit Card

A Registration Form, plot number and payment request will be sent if space is available for new members.

I understand that neither the garden staff nor the landowners are responsible for my actions. I THEREFORE HOLD HARMLESS THE FRUITFUL FIELD AND PARKWAY UNITED METHODIST CHURCH FOR ANY LIABILITY, DAMAGE, LOSS, OR CLAIM THAT OCCURS IN CONNECTION WITH THE GARDEN BY ME OR ANY OF MY GUESTS.

I UNDERSTAND ALL THESE RULES AND PROMISE TO FOLLOW THEM IN GOOD CONSCIENCE.

Name:

Signature