Garden Club Youth Gardener Registration 2018-19
SUBMIT THIS FORM TO REGISTER BY MONDAY, SEPTEMBER 17th. 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.
Email address *
Student Name *
Your answer
Student Grade & Class *
Is the student in After 3 Care? *
Student age as of 9/5/18 *
Your answer
Student birth date *
MM
/
DD
/
YYYY
Is the student a new or returning Garden Club member? *
Student t-shirt size (select a size that should last all school year) *
Student mailing address *
Your answer
Parent or guardian #1 contact information: Name *
Your answer
Parent or guardian #1 contact information: cell phone number *
Your answer
Parent or guardian #1 contact information: cell phone number - Can we text this number with Garden Club announcements? *
Parent or guardian #1 contact information: email address *
Your answer
Parent or guardian #2 contact information: Name *
Your answer
Parent or guardian #2 contact information: cell phone number
Your answer
Parent or guardian #2 contact information: cell phone number - Can we text this number with Garden Club announcements?
Parent or guardian #2 contact information: email address
Your answer
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 for each person. *
Your answer
In the event that an emergency requires medical intervention, please provide student heath insurance provider and policy number.
Your answer
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.
Your answer
PHOTO RELEASE: I give permission for my child & myself to be photographed during Garden Club activities. *
PHOTO RELEASE: I give permission for the photographs permitted above to be published in the school yearbook. (If none are permitted, select No for this question.) *
PHOTO RELEASE: I give permission for the photographs permitted above to be published in newspapers or magazines. (If none are permitted, select No for this question.) *
PHOTO RELEASE: I give permission for the photographs permitted above to be published on the KNMBG Facebook page. (If none are permitted, select No for this question.) *
PHOTO RELEASE: I give permission for the photographs permitted above to be published in a Garden Slide Show or educational video. (If none are permitted, select No for this question.) *
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. *
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. *
Required
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