After-School Garden Club

After-School Garden Club

Open to 3rd and 4th Graders at Ordway Elementary
Student Name*

First NameLast Name
Student Grade Level*
Teacher Name*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email*
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Garden Club Information

Garden Club is a six-week, after-school club designed for 3rd and 4th Graders interested in learning how seeds grow, how to plan a garden, how to start and plant seeds, garden maintenance, and the benefits of growing and eating local food. Students will get their hands dirty spreading compost, planting starts and seeds, and taking care of the garden. Participants will also learn about pollinators and hear from guest speakers, including a local farmer. The club is led by parent volunteers, Sara Daubenberger and Jessica Woersching and space is limited to 25 students.
Date & Time

Dates: 4/13 - 5/18

Mondays from 12:50pm - 2:00pm

Students meet in the STEM Room and Parent/Guardian pick-up is in front of the school
Volunteers

We welcome any parents/guardians who would like to volunteer at Garden Club meetings
After Garden Club Pick-Up Plan

If your student is being picked up, please meet them in front of the school by 2:00pm.
My child has my permission to walk or bike homeMy child will be picked up
Please contact the Garden Club leaders, Sara Daubenberger and Jessica Woersching at ordway.garden@bainbridgeptos.org with any questions.

Code of Conduct
The Code of Conduct exists in order to help foster a safe and encouraging environment for all participants. As such, it is necessary to set boundaries for acceptable participant behavior and actions. Participants are expected to abide by three core tenants of respect at all times: Respect Others, Respect the Environment, & Respect Yourself. In situations where participants choose to be disrespectful and breach the Code of Conduct, parents will be contacted and instructed to pick up their child immediately.

Zero Tolerance: The following behaviors and actions are grounds for immediate expulsion from the club.

• Physical abuse such as fighting, punching, or injuring another participant. This includes play fighting.

• Verbal or emotional abuse such as foul language, racial slurs, or hazing epithets.

• Theft, intentionally damaging property, the environment, or presenting a danger to oneself or to others.

Statement of Understanding

Parent/Guardian: I understand that I may be called at any time with an issue regarding my child. I agree to provide transportation home for my child in the event of illness, disruptive behavior, or a breach of the Code of Conduct at my personal expense, regardless of time of day or location.
Date*

MonthDayYear
Date
Signature*

Release, Indemnification & Medical Form
I hereby grant permission for my minor child to participate in Garden Club, an after-school program for students enrolled at Ordway Elementary School.

I hereby acknowledge that my child’s participation in Garden Club involves inherent risk and possible injury because of the outdoor nature of the program.

As a parent/guardian with legal responsibility for this participant, I agree on behalf of myself, my child named herein, or our heirs, successors and assigns, to hold harmless and defend the Ordway PTO, Ordway Elementary School, the Bainbridge Island School District (BISD), and their officers, employees, directors, agents, and representatives, from any and all actions and claims (including those for illness and bodily injury) losses, damages, liabilities and expenses (including attorney fees) arising out of or relating in any way to my child’s participation in Garden Club, even though said claims may arise out of the negligence of Garden Club.

I authorize provision of emergency medical care to my child if needed during participation in Garden Club when efforts to contact me and the emergency contact are unsuccessful, and I agree to be financially responsible for all costs thereof.

I represent and warrant that the information I provide on page 2 of this document fully and accurately sets forth all medical information that is relevant to my child’s participation in Garden Club.

I represent and warrant that I am the parent/guardian of the participant and that I am legally authorized to sign this document on his/her behalf. I understand and agree that this document is intended to be as broad and inclusive as is permitted by the laws of the State of Washington, and that if any portion of it is deemed unenforceable, the balance of it shall continue in full legal force and effect.
I Agree
Date*

MonthDayYear
Date
Signature*
Should be Empty:

After-School Garden Club

Garden Club Information

Emergency and Medical Information

Code of Conduct

Release, Indemnification & Medical Form