Community Food Ambassador Registration

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Please fill out this application to participate in the Food Ambassador . All participants will receive a front yard garden with the expectation of attending a minimum of one monthly activity in the garden.

First & Last Name *

Date of Birth *

YYYY

Phone Number *

Email *

Best way to contact you *

Call

Text Message

Other:

What do you identify as? *

Female

Male

Other:

Race *

Select all that Apply

Do you identify as physically disabled? *

Yes

Perfer not to say

Are you or have you served in the US military? *

Yes

Current Insurance Status? *

Private (Employer or Union)

Public (Medicare, Medicaid)

Uninsured

Underinsured

Physical Address including zip code? *

What is your ethnicity *

Hispanic

Non-Hispanic

How many people are in your household? *

Have you ever gardened before? *

Yes I am an expert at gardening

Yes I've thrown a couple of seeds in my backyard and they've grown

Yes I have a couple of plants I take care of.

No I don't know anything about gardening

Other:

What fruits or vegetables would you want to grow that you would eat at home? *

What do you hope to gain from this experience? *

How do you see this experience helping your family to bond? *

Anything you would want to specifically learn about gardening or growing your own food? *

Do you know how to prepare healthy meals options? *

Yes

A little bit

What is your shirt size? *

XXL

Please type your name as confirmation of understanding of the waiver.

By agreeing to this waiver, you will waive certain legal rights, including the right to sue. Please read this agreement carefully.

1) I am fully aware of the risks and hazards inherent to the participation in Yoga classes, workshops, and/or other activities offered by and/or taking place on the premises of 813 Hood Garden LLC (hereinafter "Hood Garden") and/or offsite. Collectively all activities offered by and/or taking place on the premises of 813 Hood Garden and/or offsite, whether specifically enumerated herein or not, will be referred to as the Activities.

The Activities may require physical exertion and may result in me being physically adjusted and/or touched by agents of Hood Garden. The Activities may be strenuous, dangerous and participating in the Activities could cause physical injury. I am fully aware of the risks, dangers and hazards involved with all the Activities in which I chose to participate and have consulted with a physician prior to participating in the Activities.

I understand none of the Activities are medical in nature and are not a substitute for medical examinations or procedures. I represent and warrant that I am physically capable of and have no medical conditions preventing me from participating in the Activities. Any behavior deemed inappropriate by Hood Garden shall result in immediate termination of the Activity, but shall not relieve my obligation to fully pay Hood Garden for the Activity. Hood Garden reserves the right to refuse to allow me to participate in any Activity for any reason deemed appropriate by Hood Garden.

2) In consideration for being allowed to participate in the Activities, I assume all risk of injury, illness, death, damage or loss to person or property, whether economic or noneconomic, related in any way to the Activities. I agree to indemnify and hold harmless Hood Garden and its agents, employees, officers, members, contractors, instructors, successors and assigns from any and all claims, demands, debts, causes of actions and liability, of every kind, whether known or unknown, arising in anyway from the Activities.

In further consideration of being allowed to participate in the Activities, I forever release and discharge Hood Garden and its agents, employees, officers, members, contractors, instructors, successors and assigns from any and all claims, demands, debts, causes of actions and liability, of every kind, whether known or unknown, arising from or related in anyway to the Activities, including, but not limited to, any such claims, demands, debts, cause of action or liabilities arising from the alleged negligence of Hood Garden.

3) Neither Hood Garden nor its agents, employees, officers, members, contractors, instructors have made any representation concerning the nature and dangers associated with the Activities other than what is stated herein. This Release and Waiver of Liability contains the entire agreement between the parties, and supersedes any prior written or oral agreements concerning the subject matter herein and cannot be modified, waived or terminated within the written consent of Hood Garden. I have read the above Release and Waiver of Liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

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