Thompson Community Garden Registration
2022 Season (April 1 – October 31, 2022)

Name_________________________________________ Phone #_____________________
	
Date of Birth_________________ (required by online registration system)

Gender _________ (required by online registration system)

Mailing Address_____________________________________________________________

E-mail _______________________________________

Emergency Contact Name _______________________________________

Emergency Contact Phone # _______________________________________

Size plot  4 X 4 ($25)□  4 X 8 ($45) □	3 X 6 ($25)□  3 X 12 ($45) □

Do you give permission for the Town of Thompson to take photos of you and you garden plot to use in promotional materials? YES □   NO □

Will you be sharing a plot? YES □   NO □ If yes, please list the other gardeners names here 
______________________________________________________________________________
______________________________________________________________________________
How did you hear about this program? Newspaper □   Radio (WINY) □   Email □   Word of Mouth □  Facebook □   Other □___________

Please return the registration form and signed Community Garden Agreement to the Recreation Office
PO Box 899
North Grosvenordale, CT 06255
860-923-9440
recreationdirector@thompsonct.org