PCGG Application Form


COPY AND PASTE THIS FORM TO A WORD DOCUMENT BEFORE COMPLETING. YOU MAY THEN EMAIL OR MAIL IT TO LLOYD.

Gardener Application for Pacific Community Garden
Group
(Read the PCGG Garden Guidelines carefully and
complete this form accordingly.)

1. Gardener: ____________________  2. Gardening partner: ____________________
3. Gardener address: ________________________________________
4. Gardener phone: ____________________
Partner phone: ____________________
5. Gardener e-mail: ____________________
Partner e-mail: ____________________
6. Number of plots requested:____
(Plots will measure, in general, 4' x 8'.)
7. How did you find out about the Pacific
Community Garden Group?
_______________________________________________________
8. Any comments (additional space on other
side)_______________________________________________________________________
9. If you are a new gardener, would you like an
experienced gardener to help you? Yes __ No __
10. If you are an experienced gardener, would you
like to help a new gardener? Yes __ No __
11. Photo permission: From time to time,
gardeners, garden leaders and the media will take
photos of the garden. Please check here ( ) if you
do not give your permission for your photo to be
published. If you do not give your permission,
please let photographers know when you
encounter them at the garden.
12. Phone and email: All gardeners are required to
share their phone number and email address with
garden leaders. In addition, a gardener phone and
email list is shared with all gardeners. Please check
here ( ) if you do not give your permission to
share your phone number and email with all
gardeners.
13. Enclose your annual fee of $15 per personal or
family plot which will be used for general
improvements to the garden. (Checks made out to
PCGG)
By signing below, I agree that I have read and
understand the PCGG Garden Guidelines and plan
to abide by all of the garden rules. I understand
that the garden group is not responsible for my
actions. I therefore agree to hold harmless the
garden group and owners of the land for any
liability, damage, loss or claim that occurs in
connection with use of the garden by me or my
guests.
Gardener Signature:________________________
Date:_________________
Please return the completed application to:
Pacific Community Garden Group
℅ Lloyd Klinedinst
10 Dover Lane
Villa Ridge, MO 63089-2001
For more information, contact:
Email: lloydk@klinedinst.com
Home: (636) 451-3232 - Mobile: (314)-609-5571

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