BEAUTY’S COMMUNITY GARDEN
3201 Airline Corner of E. 32nd
Houston, Texas 77022
(281) 756-7002
“Gardening Made Simple with Kelvin Williams”
Beauty’s Community Garden is a project Sponsored by Power Living Missions, Inc. To find out more about Power Living Missions visit
Last Name / First Name / Middle InitialStreet Address / City / State / Zip Code
E-mail / Home Phone / Cell Phone
Please indicate your age group: 5-12 years 13-17 years 18-25 26-38 39-49 50-62 63 or over
Have you previously performed any gardening? Yes No If so, how long ago?
How would you describe what type of gardener you are? Beginner Intermediate Advanced
What is the main thing that you want to take away from this class?
Would you like more information on becoming a member of Beauty’s Community Garden? Yes No
Would you like to learn about volunteer opportunities at Beauty’s Community Garden? Yes No
A few of the volunteer opportunities include administrative duties, garden advocacy, grounds keeper, gardening, etc.
Signature
Date
If under 18, signature of Parent/Guardian / Date
BEAUTY’S COMMUNITY GARDEN
3201 Airline Corner of E. 32nd
Houston, Texas 77022
(281) 756-7002
The Attached Garden Warning of Use along with the Indemnification, Waiver and Release of Liability for Participation Forms Must be Signed and Dated at the Time or Before You Begin the ClassBEAUTY’S COMMUNITY GARDEN
2014 community Garden Warning of Use statement
Beauty’s Community Garden is not staffed or supervised by any agent or
employee of Beauty’s Community Garden, Power Living Missions, Inc., The Urban Farmer or any of its affiliates.
PLEASE USE THIS GARDEN AT YOUR OWN RISK. By using this garden you agree that you understand and assume all responsibility and liability for the risks of participating in “Gardening Made Simple with Kelvin Williams.” These risks include, but are not limited to:
Loss, theft, and/or damage to person, plants and/or personal property;
Mosquitoes, ticks, chiggers, fleas, bees, wasps, hornets, spiders or other insects that may be present;
Wild animals in the garden such as rabbits, birds, skunks, raccoons, opossum, reptiles, rodents or stray dogs, all of which may cause damage, personal injury or infection;
Any personal property brought onto the premises is at your own risk.
GARDEN STUDENTS AND INDIVIDUALS ACCOMPANYING GARDEN STUDENTS USE THIS FACILITY ENTIRELY AT THEIR OWN RISK. GARDEN STUDENTS ARE RESPONSIBLE FOR THEIR OWN PROPERTY AND SAFETY WHILE USING THE GARDEN. THE CITY OF HOUSTON, BEAUTY’S COMMUNITY GARDEN, POWER LIVING MISSIONS, INC., THE URBAN FARMER OR ANY OF THEIR AFFILIATES, ASSUME NO LIABILITY FOR LOSS, DAMAGE, OR ANY KIND OF INJURY, INCLUDING PERSONAL INJURY, LOSS OF PROPERTY AND/OR DEATH SUSTAINED BY ANY PERSON WHILE USING OR VISITING BEAUTY’S COMMUNITY GARDEN.
I attest that I am at least Eighteen (18) years of age, and have read, understand and agree to the above-outlined Warnings regarding my use of Beauty’s Community Garden.
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Signature of Gardener Date
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Printed Name
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If under 18, signature of Parent/GuardianDate
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Printed Name
BEAUTY’S COMMUNITY GARDEN
3201 Airline Corner of E. 32nd
Houston, Texas 77022
(281) 756-7002
Beauty’s Community Garden
2014 Indemnification, Waiver and Release of Liability for Participation
in and Use of Beauty’s Community Garden
I, the undersigned, hereby acknowledge that I have read the foregoing information, and that I have voluntarily applied to participate and use Beauty’s Community Garden. I understand that
undertaking gardening activities and being physically present inside Beauty’s Community
Garden necessarily and absolutely involves risks of illness, injury and/or death to my-self and my guests, which risks are entirely my own responsibility. I expressly assume all these risks.
I HEREBY FOREVER INDEMNIFY, RELEASE, HOLD HARMLESS, PROMISE NOT TO SUE and WAIVE any claims, demands, losses, damages, liabilities, fines, charges, penalties, administrative and judicial proceedings and orders, judgments and all costs and expenses of any kind whatsoever, incurred therewith, including reasonable attorney’s fees and costs of defense against Beauty’s Community Garden, Power Living Missions, Inc., The Urban Farmer, and the City of Houston and/or their respective agents, officers, and employees for any and all injury, death, illness, damage or loss to property or person, sustained directly or proximately caused by any negligence of the above named parties in the use or maintenance of the premises at which said gardening activity is conducted.
I further agree to abide by all the rules, conditions and regulations pertaining to such activity as may be designated by Beauty’s Community Garden, Power Living Missions, Inc., The Urban Farmer, its agents or employees. I affirmatively state that there is no medical reason why I and/or my guests should not participate in gardening activities at Beauty’s Community Garden. I agree to assume the risk of injury to me and any individual accompanying me to Beauty’s Community Garden site. I understand that when visiting Beauty’s Community Garden, I am exposing myself, my guests and my personal property to all manner of injury and/or loss, including death.
It is my understanding that no agent or employee of Power Living Missions, Inc. will supervise Beauty’s Community Garden at any time. I further understand that neither Power Living Missions, Inc. assumes any liability for loss, damage or any kind of injury sustained by any person while using Beauty’s Community Garden. I expressly assume all risks associated with using Beauty’s Community Garden, as well as all fixtures and equipment located therein, in an unsupervised manner.
I have carefully read this waiver and release of liability and understand and fully agree with its contents.
I agree to review the Garden Warning of Use and this 2012 Indemnification, Waiver, and Release of Liability prior to my first visit to Beauty’s Community Garden.
I attest that I am at least Eighteen (18) years of age; that I have read and understand the foregoing indemnification, waiver and release of liability, agree with it and intend to be legally bound by its terms.
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Signature Date
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Printed Name
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If under 18, signature of Parent/GuardianDate
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Printed Name