KIDS CAN GROW in York County - “Kids Can Grow” 2013 Application Form
KIDS CAN GROW APPLICATION 2013
Name of Child: ________________________________________________
Child’s Age: __________
Child’s t-shirt size (circle one):
(child) S M L XL
(adult) S M L XL
Parent/Guardian Name: ________________________________________
Mailing Address: _____________________________________________
__________________________________________________________
Garden Address, if different ______________________________________
Phone: ______________________________
E-mail: ____________________________________
1. Has your child gardened before? If yes, what kind of experience does she/he have? If no, what kind of interest in gardening do they have?
2. Do you have access to a sunny space (full sun from 10:00 am – 4:00 pm) and a source of water where your child can build a 3 x 5 foot raised garden bed with their mentor (materials will be provided)?
3. Will your child be able to attend all six dates: April 27, May 11, June 1, July 20,Aug. 17, Sept. 21?
4. Do you foresee a problem attending the mandatory Parent Orientation meeting, Tuesday April 23, 6:00 – 7:00pm at the University of Maine Cooperative Extension Office, 21 Bradeen St. Springvale ?
5. Does your Child have any special needs such as physical limitations or allergies that we should know about?
Note: A Master Gardener will be assigned to “mentor” your child with his/her garden at home.
Participant’s (child’s) Signature: _______________________________
Parent/Guardian’s Signature: _______________________________
Please print and return this form, with a check for $25.00 made out to University of Maine Cooperative Extension to: Kids Can Grow University of Maine Cooperative Extension 21 Bradeen St, Suite 302 Springvale, ME 04083
Scholarships—deferred payment or partial scholarships available.
Deadline for Applications: April 5, 2013
The University of Maine Cooperative Extension offers its programs to all eligible people regardless of race, color, religion, sex, sexual orientation, national origin or citizenship status, age, disability, or veterans status in employment, education, and all other areas of the University. The University provides reasonable accommodations to qualified individuals with disabilities upon request.