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Back-Farms Garden Host Application
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First Name
*
Last Name
*
Email Address
*
Phone Number
*
Address
*
City
*
Zip Code
*
Age
*
Preferred Pronouns
*
Male (He/Him)
Female (She/Her)
Other (They/Them)
Prefer not to discuss
What is your annual household income?
*
We ask this question because our program prioritizes participants who are on a fixed income or are low-income.
How many people live in your household?
*
How many people over 60 live in your household?
*
Do you have a physical limitation that prevents you from gardening?
*
Yes
No
Do you currently rent or own your residence?
*
Rent
Own
If you rent your property, would you be able to attain permission from the property owner to install a garden?
Do you have an existing garden?
*
Yes
No
What size garden would you be willing to have in your yard?
*
Less than 300 square feet
300 – 500 square feet
more than 500 square feet
How did you hear about us?
*
Social Media
Event
Google Search
From a Friend/Word of Mouth
Senior Center Presentation or Flyer
Other
Additional Comments:
Waitlist Disclaimer:
I recognize that this application is to add my name to the waitlist to host a garden in the 2024 growing season.
Information Summary