Garden Club Youth Gardener Registration for 2023-24 school year (through August 2024)
PARENTS/GUARDIANS: SUBMIT THIS FORM TO REGISTER youth gardeners. If you are registering multiple students, please submit the form multiple times, once per student. Students who have registered online will be given paper forms to bring home for parent/guardian signature. Registration will not be considered official until the signature sheet has been received at the main office at Memorial School. All fields are required; type "N/A" if needed.
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Email *
Student Name *
Student Grade & Class *
Is the student in After Care? *
Student age as of 9/1/23 *
Student birth date *
MM
/
DD
/
YYYY
Is the student a new or returning Garden Club member? *
Student t-shirt size *
Student mailing address (number and street only) *
Parent or Guardian #1 Name *
Parent or Guardian #1 contact information: 
Please provide your cell phone number and let us know if we can text this number with Garden Club announcements.
Parent or Guardian #1 cell phone number *
Parent or Guardian #1 text preference *
Parent or Guardian #1 email address *
Parent or Guardian #2 Name
Parent or Guardian #2 contact information: 
Please provide your cell phone number and let us know if we can text this number with Garden Club announcements.
Parent or Guardian #2 cell phone number
Parent or Guardian #2 text preference
Clear selection
Parent or Guardian #2 email address
In an emergency, the Garden Club will attempt to contact the above parent(s)/guardian(s) first. Please provide any additional adult contacts who may be contacted in the event that neither parent/guardian can be reached (e.g. additional parent, grandparent, etc.). Please provide phone number(s) and email address(es) for each person.  Untitled Title
Additional emergency adult contacts (name, phone, and email) *
In the event that an emergency requires medical intervention, please provide student heath insurance provider and policy number.
Allergies: please indicate any allergies that your student has. *
Required
If any ADULTS listed above have allergies (bees, foods, etc.), please indicate their name & allergy.
PHOTO RELEASE: I give permission for photography of myself and/or my child in the following situations. Please select one option for each row. 
PHOTO RELEASE permissions: 
 *
Child
Parent(s)
Neither
During garden club activities
To be published in the school yearbook
To be published in newspapers/magazines
To be included on the KNMBG Facebook page
To be published in a Garden Slide Show or educational video
DUES: The YOUTH Garden Club Registration Donation (dues) goes towards club t-shirt, activities, and supplies. Please select your payment choice below. Payment may be made in cash or check (made payable to KNMBG) to the main office at Memorial School. All members are asked to participate in their choice of club fundraisers and/or grant-earning activities to help cover some of the club costs. 
How would you prefer to handle dues? *
PARENTS & other adult relatives are invited to VOLUNTEER - Lend a hand, chaperone, take a small or large leadership role, teach something, join a committee, support club fundraisers, share ideas, or assist as your schedule allows. Club activities are planned by Parent/Family volunteers. Garden Club Families are asked to sign up as a Garden Ambassador for their child’s class and/or volunteer to serve on a committee. Please note that public events (such as Green Fest and National Night Out) will require that students be accompanied by a responsible adult. For more info about Family volunteering email KNMBG.YouthGardeners@gmail.com.
Adult volunteering: *
Required
Family registration: In the spring, the families of each garden club member will be registered with the local garden club chapter. This registration includes insurance for adults working in the garden (at no additional cost to you), and requires that at least one adult be identified per family. Please provide us with the name of the one adult most likely to either perform gardening work or be the adult who accompanies their youth gardener to summer gardening events.
Adult(s) to be listed for family registration:  *
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