Youth Learning Garden Program
Registration is open for Food Strong's new, FREE Youth Garden program! Call 216.640.0342 or email if you have any questions. If you live close to the Market (15000 Woodworth Road, East Cle)- we MAY be able to help with transportation...let us know!
Student/Participant Name: *
Parent/Guardian Name: *
Parent/Guardian Contact Number: *
Home Address: *
Emergency Contact Name: *
Emergency Contact Number: *
The program meets on the following dates. Students should be able to attend the whole series. Please check all dates that your child will attend our workshops. *
Does the participant have any allergies? If so, list here:
In the event of a medical emergency, I hereby authorize the teacher/program personnel attending to my student to secure medical attention or hospitalization for my child. Participant's Physician's name: *
Physician's Number: *
Dismissal Information *
Do you need help with transportation? (this does not guarantee help-but we will try!!!)
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Enter any important information here:
I hereby grant Food Strong and program partners’ permission to use my child’s likeness in a photograph, video or other digital media in organizational publications, including web-based publications. *
I understand that I will not send my child to this program if he/she tests positive for COVID-19, is exposed to someone who tests positive or exhibits symptoms of COVID-19.
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YOUTH WAIVER AGREEMENT: I give permission for my child to participate in Food Strong's Youth Garden Program. I agree that my child will abide by all rules established in program to ensure safety and respect of others. Rules include showing up on time, not hitting or assaulting others, not fighting, not interrupting others, not being rude and not endangering themselves or others. All participants and leaders are required to wear protective masks, wash hands regularly and social distance to avoid illness. Temperatures will be checked at the start of each workshop. I understand that the failure of my child to observe these rules and regulations may result in his/her being excluded from participation in the program or receiving a ride from program staff/volunteers. I represent that my child is physically able to participate in the program. I fully understand that his/her participation may entail the risk of physical injury or illness. I agree to waive any claim of any kind whatsoever, whether resulting from an injury or otherwise, and further agree to release, indemnify, and hold harmless the program, Food Strong and all participating community partners from any and all liability occurring as a result of his/her participation in the program. I will be personally responsible for any financial costs incurred as a result of his/her participation in the program, including, without limitation, transportation and/or medical expenses incurred as a result of any injury. Furthermore, I understand that Food Strong assumes no liability for lost, misplaced, stolen, and/or damaged property and I hereby agree to release Food Strong from such liability. I understand that this program and all participants, volunteers and staff closely follow all state, local and CDC guidelines for COVID-19. The undersigned has read & voluntarily signed this waiver slip.
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Please sign (type) full (parent/guardian) name electronically below: *
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