Community Garden Application, Agreement, Waiver and Release Form

The following individual applies for the right to use a garden plot in the Community Action Agency of St. Louis Owner,
Inc. (CAASTLC) Community Garden (Community Garden). If given permission to use a garden plot, Applicant
agrees to the following regulations as to use and represents as follows:
Name(s) __________________________________________________________________________________________
Address: __________________________________________________ E-mail address: ________________________
Telephone Number: _________________________________

Days or Evenings: ______________________________

Community Garden Site Preference:

____________________________________________________________________________________
Applicant would like a garden next to a friend; Name: _____________________________________________________
Applicant has gardened before at (where?); for how long? ___________________________________________________
Please briefly describe Applicants gardening experience. ___________________________________________________
__________________________________________________________________________________________________
Please describe why Applicant wants to participate in the Community Garden. __________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
COMMUNITY GARDEN REGULATIONS
Applicant states and agrees as follows:

1. If I must abandon my plot for any reason, I will notify the garden leadership.
2. I will keep weeds at a minimum and maintain the areas immediately surrounding my plot.
3. If my plot becomes unkempt and overgrown, I understand I will be given one (1) week's notice to
clean and weed it. At that time, it may be re-assigned or tilled in.
4. I will keep trash and litter out of the plot, as well as from adjacent pathways and fences.
5. I will participate in the fall cleanup of the garden.
6. If I plant tall crops, I will assure they will not shade neighboring plots.
7. I will pick only my own crops unless given permission by another plot user.
8. I will not use fertilizers, insecticides or weed repellents that will in any way affect other plots.
9. I agree to volunteer hours toward community gardening efforts.
10. I will not bring pets to the garden other than a seeing assist dog.
11. I understand that neither the garden group nor owners of the land are responsible for my
actions.

12. I am eighteen years of age or older or my parent or legal guardian has signed below.
13. I will use the garden plot assigned to me only in accordance with the Community Garden
Regulations included herein or as may be otherwise announced from time to time.
14. I understand that the Community Garden is located on land owned by ______________
(Owner) and that Owner reserves the right to take full possession of all or any part of the
Community Garden and remove the garden plots, plants, improvements, and other personal
property located on that the land at any time.
15. I also understand that the right to occupy and use a garden plot does not create a real property
tenancy but rather a limited and fully revocable license
# of
Monthly
More Less
for such use.
Members Income
Than
Tha
in Family
n
16. I understand and agree there shall be no use of tobacco,
alcohol or any illegal substances of any kind on the
1
$ 1,238
premises.
2
$ 1,669
17. I authorize photograph(s) and/or videotaping to be taken
of me by CAASTLC solely for the purposes of promotion,
3
$ 2,100
documentation, and/or possible publication in
4
$ 2,531
newspaper(s), CAASTLC report(s), CAASTLC in-house
5
$ 2,963
materials, and/or the general media. I understand that
neither I nor anyone else in my family will receive
6
$ 3,394
compensation from CAASTLC for such photograph(s)
7
$ 3,826
and/or videotaping. The use of all such photograph(s)
and/or videotaping shall be the sole and exclusive
8
$ 4,259
property of CAASTLC.

CAASTLC is federally funded. We seek to collect demographic information from program participants to help
improve the effectiveness of our programming among low-income residents of St. Louis County.
Please read the table to the right and check the category of household income that best describes your family.

Are you OR any member of household over age of 55?

____ YES ___ NO
Are you OR any member of household disabled?
____ YES ___ NO

WAIVER AND RELEASE

In consideration for the license granted to use the Community Garden, I hereby waive and release CAASTLC and
Owner, and their officials, employees, agents and insurers from any claim, loss or liability for death, personal
injury, or loss or damage to personal property arising out of my use of the Community Garden unless arising out of
CAASTLCs and/or Owners intentional wrongful acts. I understand that Owner may provide gardeners notice of
its intent to re-take full possession of the Community Garden land but I fully understand and agree that any lack

of such that notice will not prevent Owner from taking possession of its property and removing any garden plots,
plants and personal property located on the Owners land, including my own. In such event, I waive any claim for
loss or damage. I agree to fully indemnify, defend and hold harmless CAASTLC and/or Owner, and their officials,
employees, agents and insurers from any claim or loss or liability made against CAASTLC and/or Owner, and
their officials, employees, agents or insurers by an invitee of mine for death, personal injury, or loss or damage to
personal property arising out of my use of the Community Garden unless arising out of CAASTLCs and/or
Owners intentional wrongful act. I agree that this waiver and release shall be governed by Missouri law.
Dated: ________________, 2017
Signature of Applicant / Gardener: _____________________________
If Applicant is under age eighteen: the parent or legal guardian of the Gardener agrees to the foregoing:
Signature of Parent / Guardian: _________________________