Parent Place

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Permission Form

Parent/Guardian Sign-Up & Participation Agreement

Thank you for your interest in the Hope Road Youth Gardening Program! Please fill out the information below. This helps us keep your child safe, engaged, and supported while participating in our activities.

Youth Information

Full Name of Youth:

Age

Birthday

Month

Day

Year

School (If Applicable):

Allergies/Medical Conditions (if any):

Parent/Guardian Information

Full Name:

Relationship to Child

Phone

Home Address

Emergency Contact (Other than Parent/Guardian)

Name

Phone

Relationship to Child:

Terms of Participation

By signing below, I understand and agree to the following:

My child will participate in gardening and outdoor activities, including handling soil, tools, and plants under supervision.

I agree to notify Hope Road of any health conditions or limitations that could impact my child’s participation.

I release Hope Road Organization and its volunteers from liability in case of minor injuries that may occur during regular programming.

I grant permission for photos/videos of my child to be used for program promotion and community engagement.

(Check here if you do NOT consent to photo/video use.)

I will ensure my child is picked up promptly after each session unless otherwise communicated.

I understand that the program is free and open to youth ages 6–18. Younger children may participate only with a guardian present.

Signature

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Thank you for allowing your child to grow with us! 🌻

Questions? Call or text us at 937-317-1926 or email info@hoperoad.org