UHSC Grow & Give Initiative – Applicant Registration Form

🌱 Program Start: Spring 2026

📍 Location: UHSC Urban Farm

👥 Open To: Youth, Adults, Seniors, Volunteers & Families

1. Applicant Information

Full Name

Date of Birth

Phone Number

Email Address

Home Address

2. Emergency Contact

3. Participation Category (Select all that apply)

Youth (Ages 12–17) Adult Senior Family Participant Volunteer Community Organization Partner

4. Program Interests

Growing vegetables (spinach, peppers, tomatoes, cabbage, etc.) Raised bed gardening Composting & soil health Watering & irrigation basics Harvesting & food distribution Urban agriculture leadership Community service hours (youth) Stipend eligible participation

5. Experience Level:

6. Availability (Select all that apply)

Weekdays (Morning) Weekdays (Afternoon) Weekdays (Evening) Saturdays Sundays Flexible / As needed

7. Why Do You Want to Join the Grow & Give Initiative?

8. Health or Physical Considerations (Optional)

9. Consent & Agreement

I agree to participate in UHSC Grow & Give activities.
I understand that gardening involves physical activity.
I give permission for UHSC to use photos/videos of program activities for community outreach (optional).

I agree to photo/video use I do NOT agree to photo/video use

10. Parent/Guardian Consent (For Youth)

I give permission for my child to participate in the UHSC Grow & Give Initiative.