This document is a sign-up sheet for an Earth-Sheltered Community Garden program located at 4510 and 4538 N 65th Ave in Omaha, NE. It provides information on participation requirements, including that children under 12 must be accompanied by an adult and those ages 13-17 need parental permission. Gardeners can tend to their plots from sunrise to sunset. The sheet collects participants' contact information and has them sign a waiver assuming risk and releasing the program from liability for any injuries occurring during activities.

1. Earth-Sheltered (Community) Garden Sign-Up Sheet
All participants are invited to participate in this program at the Earth-Sheltered (Community)
Garden at 4510 and 4538 N 65th Ave, Omaha, NE 68104.
All children 12 years of age and younger must be accompanied by an adult at all times.
Minor children ages 13 & up must have parental permission & check-in at 6572 Ames Ave.
Gardeners can come and go, as needed, to tend to your plot and other organized activities
between sunrise and sunset.
Participant(s) Name: _____________________________________________________
Age(s): _______________________________________________________________
Parent’s Name: _________________________________________________________
Address: ______________________________________________________________
City: ________________________ State: _________ Zip Code: __________________
Phone: ______________________ E-mail: ___________________________________
_____________________________________________________________________________________
Waiver and Release of All Claims and Assumptions of Risk
Please read this form carefully and be aware that in signing up and participating in the Earth-Sheltered (Community)
Garden program, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for
injuries, damages, or loss which you or your child/ward might sustain as a result of participating in any and all
activities connected with and associated with this program.
I recognize and acknowledge that there are limited risks of physical injury to participants in this gardening/nature
program, and I voluntarily agree to assume the full risk of any injuries, damages, or loss, regardless of severity that
my minor child/ward or I may sustain as a result of participating in any and all activities connected with or
associated with this program. Further, I permit the taking of photos during Earth-Sheltered (Community) Garden
activities for publication and use as the program deems.
I have read and fully understand the above important information, warning of risk,
assumption of risk, and waiver and release of all claims.
______________________________________________________________________________
Participant's Name (please print)
_________________________________________________________________________ ______________
Guardian’s Signature Date