Maysie’s Farm Conservation Center
Down to Earth Gardening Workshop for Youth
Registration Form

Workshop Date:

Thursday, June 19, 2007 ____

The staff and volunteers from Maysie’s 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 Maysie’s 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:
Maysie’s Farm Conservation Center
15 St. Andrew’s Lane
Glenmoore, PA 19343
(610) 458-8129

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