Plowbreak Farm ~ 2017 Healthy Food For All Solidarity (subsidized) CSA Share Application ~
Sign me up! For 23 weeks of abundant locally grown, organic produce!
Spaces are limited and reserved on a first come, first serve basis. To ensure your space, fill out and submit this application and send in your check today!

Send deposit to:
Plowbreak Farm: 4106 Covert Road, Burdett NY 14818
To pay using Cash or EBT-Food Stamps, please contact the farm.

***PLEASE NOTE- Your space in the CSA is NOT reserved until your DEPOSIT is RECEIVED by the farm.***
Thanks!

Questions? Please get in touch! Email: plowbreakfarm@gmail.com

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SPECIAL INFORMATION regarding our shares:

Plowbreak offers 2 different SHARE TYPES:

- Free- Choice Shares in downtown Ithaca ON THURSDAYS 5-8pm at the Westy (516 W State St Ithaca)
- Boxed Shares on the farm ON MONDAYS 3-7pm at the farm in Burdett


SHARE SIZES:

- 2-Adult Household Share (includes kids 12 and under) is $287.50
- Family Share is $287.50 plus $50 for ever household member over 12


Member Info!
Name
Your answer
Address
Your answer
Phone number(s)
Your answer
Email
Your answer
Income Eligibility Info!
Income Eligibility Charts
please refer to the charts below and confirm that you are income eligible for the HFFA Solidarity CSA Share.
My household is income eligible for HFFA Solidarity CSA Shares
Please refer to the above charts and confirm that your household is income eligible. Eligibility is determined by gross income (before taxes) and family size.
CSA Share Info!
I have read and agree to the Plowbreak Member Guide available here: http://www.plowbreakfarm.com/faqsmember-guide.html
I am applying for the following Share Size and Payment option:
Please make sure you check the correct csa share size and payment option!
I will pick up my share at:
I would like to pay for my share using EBT/Food Stamps
If using EBT to pay for your share, please contact your farm.
Important note regarding EBT! HFFA is happy to take EBT payments for your CSA share! EBT payments can be made at Greenstar Cooperative Market. After making your EBT payment at Greenstar, you MUST save your receipt and provide it to your farmer ASAP, with you name written on it, as proof of payment. If you fail to provide your Farmer with a copy of your EBT payment receipt, your payment will not count! HFFA CSA members are also eligible to become members of Greenstar's FLOWER program. FLOWER members receive a 15% discount off most products purchased at Greenstar! And membership can automatically verify CSA payments made via EBT at Greenstar.
for more information on the FLOWER program please visit http://www.greenstar.coop/flower or contact healthyfoodforall.ithaca@gmail.com.
Demographic Info!
Healthy Food For All is made possible through grants that require us to report the following information. Your answers will remain strictly confidential. Thank you.
How many adults are in your household?
Your answer
How many children are in your household?
please also indicate their ages
Your answer
Is your household a single-parent family?
a single-parent family as defined by one parent who lives with their dependent child(ren) alone -or- in a larger household without a partner.
Do any of the children in your household attend Beverly J. Martin Elementary School?
Do any of the children in your household participate in programs at GIAC and/or Southside Community Center?
Please indicate which programs you participate in:
please check all that apply
Did you participate in a CSA last year?
How did you hear about Healthy Food For All?
please check all that apply
On average, how many servings of fruits and vegetables do you consume in a week?
1 serving = 1 cup salad or 1/2 cup cooked vegetable or 1/2 cup fruit
Your answer
On average, how many servings of fruits and vegetables do the children in your household consume in a week?
Your answer
On average, how many different types of vegetables do you consume in a week?
Your answer
On average, how many different types of vegetables do the children in your household consume in a week?
Your answer
What ethnicity do you identify with?
Your answer
How often to you check your email?
Important Info regarding your Deposit!
***PLEASE NOTE- Your space in the CSA is NOT reserved until your DEPOSIT is RECEIVED by the farm.*** Thanks!
if you plan to pay your deposit using EBT/Food Stamps, please contact the farm
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