Urban Farming Liability Waiver Form

Participant Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred Contact Method

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Emergency Contact Name

First NameLast Name

Relationship to Participant

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Any conditions, injuries, allergies, mobility limitations, or other restrictions relevant to safe participation in urban farming activities?

Please provide details of any conditions, injuries, allergies, mobility limitations, or other restrictions

Relevant experience or familiarity with gardening or farm work

Preferred Participation Date and Time

Program Site or Activity Area

Preferred Tasks and Areas of Interest

Attendance Notes or Scheduling Preferences

Participant Signature