FBGA
The Floyd Bennett Gardens Association, Inc.
 Floyd Bennett Field • 1 Ryan Visitors Center • Brooklyn, NY 11234 • 718.338.4255

Children’s Garden Membership Application

Please Print All Requested Information Clearly.

Mail application to: FBGA - PO Box 340986 - Ryder Retail Station - Brooklyn NY 11234-9993

Name of Child:_________________________________________________________________________________

School: Grade: ________________________________________________________________________________

Parent or Guardian’s Name:_______________________________________________________________________

Address: _________________________________________________________Apt#________________________

City:_______________ State:_______________ Zip Code:______________________________________________

Telephone  Home:_________________ Work:______________  Cell:_________________ Pager:________________

E-mail Address: _______________________________________________________________________________

Please indicate any special or important needs: ________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Emergency Contact Information (please list a contact name and phone)

Name:___________________________________________ Telephone #____________________________________

Parent and Child Agreement

I give my child _______________________________________________________ permission to participate in the FBGA

Print Name Name of Child __________________________________________________________________________

Children’s Garden Program. I agree to be present at the community garden when my child attends.

Print Name of Parent or Guardian and Plot Number Signature of Parent or Guardian _________________________________

_____________________________________________________________________________________________

I am willing to attend workshops or other gardening programs in the Children’s Garden. I will work cooperatively
with my instructors or guides and fellow gardeners. I will be respectful and kind to my fellow Gardeners and
follow the Rules and Regulations of FBGA.

Signature of Child:____________________________________________ Date ________________________________

FBGA/REGISTRATION RULES AND REGULATION DOC 2007. REVISED 10-22-06