Garden Club Youth Gardener Registration 2019-2020

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SUBMIT THIS FORM TO REGISTER BY MONDAY, SEPTEMBER 16th. Students who have registered online will be given 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 3 Care? *

Yes

Student age as of 9/4/19 *

Student birth date *

AAAA

Is the student a new or returning Garden Club member? *

New

Returning

Student t-shirt size (select a size that should last all school year) *

Student mailing address (number and street only) *

Parent or Guardian #1 Name *

Parent or Guardian #1 contact information: cell phone number *

Parent or Guardian #1 contact information: cell phone number - Can we text this number with Garden Club announcements? *

Yes

Parent or Guardian #1 contact information: email address *

Parent or Guardian #2 Name *

Parent or Guardian #2 contact information: cell phone number *

Parent or Guardian #2 contact information: cell phone number - Can we text this number with Garden Club announcements? *

Yes

Parent or Guardian #2 contact information: 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. *

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. *

No known allergies

Bees

Peanuts

Tree nuts

Dairy

Altro:

Obbligatorio

If any adults listed above have allergies (bees, foods, etc.), please indicate their name & allergy.

PHOTO RELEASE: I give permission for my child & myself to be photographed during Garden Club activities. *

Yes for student and adults

Yes for student only

PHOTO RELEASE: I give permission for the photographs of the person(s) permitted above to be published in the school yearbook. (If none are permitted, also select No for this question.) *

Yes

PHOTO RELEASE: I give permission for the photographs of the person(s) permitted above to be published in newspapers or magazines. (If none are permitted, also select No for this question.) *

Yes

PHOTO RELEASE: I give permission for the photographs of the person(s) permitted above to be published on the KNMBG Facebook page. (If none are permitted, also select No for this question.) *

Yes

PHOTO RELEASE: I give permission for the photographs of the person(s) permitted above to be published in a Garden Slide Show or educational video. (If none are permitted, also select No for this question.) *

Yes

DUES: The Annual 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. *

I will send in $25 no later than October 11th (this is a $5 discount)

I will pay on the installment plan: $15 by October 11th + $15 by February 14th

Fee reduction to $15 due October 11th: My student volunteered at one grant-earning summer activity (KAQ Hospice event, Washington Boro Green Fest, and National Night Out) to earn a dues decrease (this will be checked against the sign-in sheet)

Fee waiver: My student volunteered at two or more grant-earning summer activities (KAQ Hospice event, Washington Boro Green Fest, and National Night Out) to earn a dues waiver (this will be checked against the sign-in sheet)

I would like to request a Youth Garden Club Scholarship that is available for families unable to pay the club donation. I understand that I will need to write a note as soon as possible to request a GC Scholarship. Address to the attention of Ms. Migliorino - Garden Club.

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. *

Parent / guardian #1 is able to volunteer in some capacity

Parent / guardian #2 is able to volunteer in some capacity

None of the adults listed above can volunteer.

Altro:

Obbligatorio

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