Kitsap Harvest Volunteer Application Form PART A
A program of Washington State University Kitsap Extension. To be completed by all potential volunteers in conjunction with Form B, Background Disclosure.
Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number (for a quick way to get a hold of you before a glean if something changes) *
Your answer
Mailing Address (Street) *
Your answer
Mailing Address (City) *
Your answer
Mailing Address (Zip Code) *
Your answer
How did you hear about Kitsap Harvest Gleaning Project?
What part of being on the glean team interests you? *
Your answer
How do you want to help? (Check as many as you want)
What experience do you have with food and gardening? (check all that apply) *
Select yes for the areas you are willing to travel for gleaning in Kitsap County. Otherwise, please check no. *
Bainbridge Island
North (Poulsbo to Hansville)
Central (Bremerton, Silverdale and Seabeck)
South (Gorst to Pierce County line)
Are you currently receiving food assistance? (Our primary goal is to increase access to fresh food. We do not share any of your information.)
Please provide us with 1 or more reliable emergency contact(s). In the format: Name, Relationship, Phone Number *
Your answer
Do you have any health or medical conditions which we should be aware of? *
If you answered yes to medical conditions, please explain.
Your answer
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