2015 FLOWER SHARE REGISTRATION

MEMBER INFORMATION
o School Staff

o Family of Student

o Community Member

Name/s:
Please include names of all people sharing membership

Address:
Phone:

Email:
CSA membership fees are NOT tax-deductible.

MEMBERSHIP COST:
o $215, full share

PAYMENT:
o Full Payment: Include a check for the total share cost
(DUE JUNE 1)

PICKUP LOCATION:
o WEDNESDAY 2:30 pm - 6:30 pm at the Youth Farm (600 Kingston Avenue)
o MONDAY 5 pm - 8 pm at Shambhala Yoga and Dance Studio (367 St. Marks Avenue)

FLOWER SHARE CSA MEMBERSHIP AGREEMENT:

I commit to membership in the 2015 Youth Farm

Flower CSA. I will pick up my share every week from
June 22 through October 12 (Shambhala pickup) or
from June 24 through October 14 (Youth Farm
pickup). If I am unable to pick up my share, I will
have a friend or relative pick up for me, or forfeit my
share that week.
I understand that CSA involves sharing the rewards
and risks with the farm. I understand that my share
may vary from week to week, and that there is no
guarantee of the exact amount of my share.
I agree not to hold Green Guerillas, the High School
for Public Service, BK Farmyards, or anyone acting
on its behalf, including any agents, officers,
volunteers or employees, responsible for any
damages resulting from injuries sustained while
engaged in any event or activity, including but not
limited to weekly distribution or volunteer days.
I hereby authorize Green Guerillas and HSPS to
use, reproduce, and/or public all written and/or
visual materials, including photographs that may
pertain to me. I understand that this material may be
used in various publications, public affairs releases,
recruitment materials,

or for other related endeavors. This authorization is

continuous and may only be withdrawn by my specific
rescission of this authorization.
Through membership in the HSPS Youth Farm CSA I am
supporting a local food system and bringing healthy food
to our community.
I have read this agreement and agree to the terms:

Signature

Date

Please mail completed application

and checks to:
Green Guerillas
232 E. 11th Street
New York, NY 10003
Checks payable to:
Green Guerillas
Please write CSA in the memo line.
Membership is granted on a first-come, first
serve basis with preference given to HSPS
parents.

For more information, visit www.hspsfarm.blogspot.com