HYDROPONIC FARM PRODUCE PROGRAM Registration

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HYDROPONIC FARM PRODUCE PROGRAM Registration

I am interested in qualifying for the FREE weekly produce program being offered by

SaltWater Community Association.

I understand that if I qualify I will be contacted and

provided additional information in the coming months once the farm has been

established.

As part of the project requirements participants will be asked every three (3) months to
identify any change in their health as a result of eating fresh locally grown produce.

Name: *

Town *

How many people live in your household:
*

Your annual household income: *

*Proof of income MAY be required

less than $20,000

$30,000 - $40,000

$40,000 - $50,000

over $51,000

Required

Do you like:
*

*Multiple answers could be choose

lettuce

baby greens

green onions

peppers

herbs

Required

Do you have any of the following health conditions: *

*Multiple answers could be choose

diabetes

pre-diabetes

high blood pressure

high cholesterol

diet related illness

none

Required

If you have diet related illness, please explain:

Thanks for registering for the program!

SaltWater Community Association

Address: 7-25 Old Days Pond Rd. Bonavista, NL A0C 1B0
Contact us at (709) 468-7042 or saltwatercommunityassociation@gmail.com

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