2. 
3. 
5. Name*
6. Email Address*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Primary Phone*
15. Secondary Phone *
17. House Hold Plot?*

    1. Yes
    2. No
18. Individual Plot?*

    1. Yes
    2. No
19. Are you wheelchair bound?

    1. Yes
    2. No
21. I want to share a plot.*

    1. Yes
    2. No
22. If shared, please list the name of the individual.
23. Which Community Garden are you interested in?

    1. Jay Perry
    2. Hansen Park
25. I agree to comply with all rules and regulations established by the City of Kennewick and the Hansen Park Community Garden Committee. Either I or a member of my household will be a member of the Garden Committee to manage the garden during the 2020 season. Participation in a community garden with the City of Kennewick is a voluntary activity. In consideration of permission to participate in this activity, I hereby agree to assume the risk of damaged, lost, stolen, or neglected property, injury, illness or death associated with participation in this activity. I agree to release the City of Kennewick, its employees, agents, representatives and volunteers and Washington State University Extension and it’s Master Gardeners from any and all liability that may arise in connection with this activity. I agree that the terms hereof shall serve as an assumption of risk and release for my heirs, estate, executor, administrator, assignees and for all members of my family. Furthermore, I give permission to have my photo/video taken, without recompense, during City of Kennewick volunteer activities, which may be used for public relations, grants or publicity purposes.
27. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature*
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field