Maysies Farm Conservation Center
Down to Earth Gardening Workshop for Youth
Registration Form
Workshop Date:
Thursday, June 19, 2007 ____
The staff and volunteers from Maysies Farm Conservation Center are looking forward to spending an exciting day with your child (children). Please provide us with the following information about your child (children):
Name(s) of child (children) participating in workshop: ________________
____________________________________________________________
Age(s) of child (children): ______________________________________
Are there any allergies, medications or medical conditions of which we should be aware?
______________________________________________
Parent Name _______________________________________________
Address _______________________________________________
_______________________________________________
Phone Number _______________________________________________
Email _______________________________________________
In case of emergency:
Name and phone number of contact person on the day of workshop
____________________________________________________________
How did you hear about the workshop? ____________________________
Workshop Time: 8:30 AM 2:00 PM. Rain date to be announced.
Cost per child: $30 registration fee ($25 for Maysies Farm CSA Members) covers instruction, a fresh-from-the-field lunch, and take home plants. Some scholarships are available. Session is limited to 20 participants
Print this page and mail with a check made payable to:
Maysies Farm Conservation Center
15 St. Andrews Lane
Glenmoore, PA 19343
(610) 458-8129
Email: organic@maysiesfarm.org