Community Garden Participant Application
INSTRUCTIONS: Please return application, waiver, and payment to Mountain Roots In person: 202 E Georgia Ave By Mail: PO Box 323 Gunnison CO 81230 By Email to: [email protected] GENERAL INFORMATION # of Plots _______ YEAR:________ Name: ! Cottonwood Community Garden th
Mailing Address: 12 & Gothic, Gunnison ! Giving Garden at Bill’s Park th
Best Phone: 14 & Virginia, Gunnison ! Elk Avenue Garden E-‐mail: 202 Elk Ave, Crested Butte Check all that apply: ☐SNAP ☐ WIC ☐ Free-‐Reduced School Lunch ☐ Mountain View Apartments PLOT INFORMATION COTTONWOOD A 4’ x 13’ plot is $30/plot per growing season, available May 15 – November 15, and includes access to water and hoses. Garden fees are used to pay for water and electricity and contribute to a general fund for maintenance of common areas. Gardeners are encouraged, but not required, to “grow a row” for the hungry and donate any surplus food. * Please note that THERE ARE NO BATHROOMS at this garden. Plan accordingly! GIVING GARDEN at BILL’s PARK Participation priority is given to low-‐income residents, and fees are accepted on a sliding scale from $0 to $30 per season. For gardeners who do not meet low-‐income guidelines, the suggested donation is $30 / season. All gardeners receive an abundant share of the food grown. As a ‘rule of thumb,’ fifty percent (50%) of the food grown at the Giving Garden is donated. Plots will be given on a first come, first serve basis. If all plots are reserved, your name will be put on a waiting list in order that interest was expressed. th
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The gardens will open May 15 . If you decide not to garden, you must inform the garden manager before June 5 th
for a $20 refund (we withhold a $10 processing fee). If you have not begun to work in your plot by June 5 or made prior arrangements with the garden manager, you will forfeit your use of the plot along with the full fee. The plot will be given to the next person on the waiting list. Please initial: ____ I have read and fully understand the above conditions ____ I have received a copy of the Garden Guidelines; I have read them, understand them, and I will be held accountable to them ____ I have included a signed liability waiver PLOT FEES I am able to contribute $_____ toward my plot fee. [Cottonwood = $30. Giving Garden = Sliding Scale, enter $0 to $30. Make checks payable Mountain Roots, please write the name of your garden in the memo line] COMMUNITY SUPPORT DONATION $ ________ I would like to contribute this amount in support of Mountain Roots valley-‐wide programs and projects that are working together to build a resilient food system for Gunnison Valley. Signature Print Name Date v
Mountain Roots | PO Box 323 Gunnison, CO 81230
970.417.7848 [email protected] Advisement of Risk, Release of Liability, Hold Harmless and Indemnification Agreement, Medical Authorization, and Photo Release Please read this form carefully and be aware that in registering yourself or your child for participation or volunteering for this Program, you are advised of the risks, which you may experience as a result of participating in this program. I, the undersigned student, volunteer, camper, visitor, guest, participant, or parent thereof understand and acknowledge The Mountain Roots Food Project’s Farm to School, Gardens, and Access & Outreach programs include activities in which, despite preparation, instruction, medical advice, conditioning and equipment, there is still a risk of injuries. Properties on which field work is done are in a “natural state,” which includes but is not limited to the presence of bees, ticks, insects, birds, and other indigenous creatures such as snakes, lizards, rodents, and certain plants which contact with may result in burning, blisters, itching, and other symptoms. I understand and acknowledge that participation in some field work includes physically demanding work. By my signature hereunder on behalf of myself or my child, I certify that I am physically fit and have / has no medical conditions which would preclude me or my child from performing physically demanding work. I further understand and acknowledge that I am required to follow protocols, standard operating procedures, and food handling safety with respect to Mountain Roots Food Project’s policies. My participation in Mountain Roots Food Project is voluntary. I understand the above conditions and the risks occasioned by my or my child’s participation in the program to include but not be limited to physical injury, including bodily harm and death, muscle strain and other muscle injuries, foot problems, sun and heat stroke, dehydration, and health related conditions arising from certain plants, animals, and insects, such as West Nile Virus, Lyme Disease, Rocky Mountain Spotted Tick Fever, and Hantavirus. _____ In consideration of my participation, I hereby ACCEPT RESPONSIBILITY AND EXPRESSLY ASSUME ANY AND ALL RISKS occasioned by and related to these conditions and related to my or my child’s participation in Mountain Roots Food Project activities and programs. I expressly agree to HOLD HARMLESS, INDEMNIFY, and FOREVER RELEASE for any and all claims now or in the future which may arise against, and agree not to sue, the Mountain Roots Food Project, the City of Gunnison, and the Town of Crested Butte, and their officers, agents, employees and authorized volunteers, on my behalf as a result of participating in the program. _____ I further agree to indemnify, hold harmless and defend Mountain Roots, the Community Foundation of the Gunnison Valley, the City of Gunnison, and the Town of Crested Butte and their officers, agents, employees, and authorized volunteers from any and all claims by other parties resulting from injuries, damages and losses caused by me arising out of, connect with, or in any way associated with the activities of the Program. This release is a COMPLETE WAIVER of any and all warranty claims regarding the content and safety of Mountain Roots Food Project and the activities and programs therein. By execution of this Release, the undersigned expressly agrees not to sue, and acknowledges that he/she is releasing any and all rights to make a claim or file a lawsuit against Mountain Roots Food Project, the City of Gunnison, and the Town of Crested Butte. In the case of a minor child (under eighteen years of age) the undersigned parent or legal guardian acknowledges that he/ she is signing this Release on behalf of a minor, that the minor shall be bound by the terms of this Agreement and Release, and that the parent or legal guardian is waiving certain rights on behalf of the minor child that the minor child may have. _____ MEDICAL RELEASE: In the event of any emergency, I authorize Mountain Roots officials to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my immediate care and agree that I will be responsible for payment of any and all medical services rendered. _____ PHOTO RELEASE: I understand that photographs may be taken by Mountain Roots during this program. I grant Mountain Roots permission to use my likeness in photograph(s) in any and all publications and in any and all other media now and in the future. I will make no monetary or other claim against Mountain Roots concerning the photograph(s). I have read and fully understand the above, and sign it voluntarily. I understand this agreement shall not be modified orally. Participant 1 Name____________________________________________ Birthdate _____________ __ Male __ Female Participant 2 Name____________________________________________ Birthdate _____________ __ Male __ Female Participant 3 Name____________________________________________ Birthdate _____________ __ Male __ Female Participant 4 Name____________________________________________ Birthdate _____________ __ Male __ Female ____________________________________________________________ _________________________ ___________________________ Mailing Address Phone email ___________________________________________________________ __________________ Signature of Participant or Parent / Legal Guardian of Minor Participant Date v
Mountain Roots | PO Box 323 Gunnison, CO 81230
970.417.7848 [email protected]