Perlman Place Community Garden Membership Application
1950 Perlman Place Baltimore, MD 21213
Name: *
Under 18? *
Email *
Phone Number *
Best way to be reached (check all that apply) *
Please check crops that you would be interested in growing (Cool/Warm) *
What is your availability to work at the garden? (Indicate time of day in "other" section)
What are you interested in learning from the community garden? *
How did you hear about us? *
Forbidden Activities
1. I will not plant any illegal plants. I will not smoke, drink alcoholic beverages, use illegal drugs, or gamble in my garden. I will not come to the garden while under the influence of alcohol or illegal drugs. I will not bring weapons or pets or other animals to the community garden.

2. Guests, including children, may enter the garden if they comply with the rules and regulations stated here. I am responsible for and will supervise my guest (including children).

3. I will not apply any pesticides in the garden without the approval of the Civic Works' garden/farm manager.

4. I will not take food or plants from other gardener's plots or the farm without permission.

5. I will not use profane or offensive language in the garden. I forfeit my right to sue the owner of the property, Civic Works' Real Food Farm.
Responsibilities, terms and conditions as a community garden member
If accepted, I agree to the following rules, terms, and conditions:

1. My use of this garden is at the sole discretion of the Civic Works' Real Food Farm Perlman Place Community Garden. I agree to abide by its policies and practices.

2. The fee for the use of the garden is free for all Baltimore City residents.

3. Once assigned plot, O will cultivate and plant it within a month. I will not leave my plot unmaintained or unused for any period of 6 weeks or longer. If I neglect my plot for 4 weeks or longer, I lose rights to my plot.

4. My plot is (__x__) feet. I will not expand my plot beyond its measure or into others. I will keep all my plants within the limits of my plot and will not allow any plants to grow more than 6 feet high.

5. I will keep my plot weeded and the surrounding areas clean and neat. I will not leave personal belongings at the garden.
Liability Waiver
As a volunteer with Civic Works, I understand that the volunteer work I perform may involve physical activities, contact with unidentified, unfamiliar persons and unidentified substances, travel to and from unspecified locations, and potential risks of injury. Knowing this, I still wish to volunteer and I assume the risks of any accident or injury to person or property which I may experience.

I understand I am responsible for my own personal safety, belongings, equipment and automobile while working on Civic Works projects. I acknowledge that I am physically able to do the work associated with this project. I agree that I will only perform volunteer activities that I am comfortable doing.

I release all liability and responsibility from and will not take action against Civic Works, any of its directors, officers, agents, employees, affiliates, partners or successors or the owners and/or developers
of any property I access to perform this volunteer work because of any accident, injury, property
damage, expenses, losses or damages which I might experience due to my involvement with this
volunteer activity.

In case of emergency, accident or illness, I give my permission to be treated by a professional medical
person and be admitted to a hospital, if necessary. I agree to be responsible for all of my own medical

I give permission to have photos or videos taken during the volunteer activity and published with my
name for publicity purposes without compensation. I understand that the information I fill out below
will not be shared with outside organizations and may be used to inform me about Civic Works
activities and volunteer opportunities.

By clicking "yes" below I confirm that I have read the above statement, I understand it and I fully accept its
terms. (If there are terms you do not accept, alter them to your approval and sign below). If using an
electronic signature: I understand that execution of this waiver using the electronic signature option is
binding upon me.
Emergency Contact Name
Emergency Contact Phone
Allergies or Special Needs
Guardian Name (if under 18)
Do you accept the previous terms and conditions? *
Never submit passwords through Google Forms.
This form was created inside of Civic Works. Report Abuse