Community Garden Application

Community Garden Application

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Please select your language:

ERROR: Missing necessary information. Please reach out to us for a corrected link to this form.

basic contact INFORMATION

First Name

Last Name

Phone Type

MobileHomeWorkOther

Mobile

Home Phone

Work Phone

Other Phone

Address Line 1

Address Line 2

City

State

Provinces

Postal Code

Email

Preferred language

Do you speak any other languages?

YesNo

What languages?

255 characters left.

Page 2

Garden Participation PREFERENCES

Please indicate your FIRST garden of preference. We encourage you to sign up for gardens closest to your home.

Rotary Club Park Community Garden - 22 Richmond Ave. Lowell (Back Central)Smith St. Community Garden - 36 Smith St., Lowell (Lower Highlands)Armory Park Community Garden - 46-90 Westford St. (Lower Highlands)West 3rd Community Garden - 66 West Third St., Lowell (Centralville)Eagle Park Community Garden - 95 West 6th St., Lowell (Centralville)Hampshire Street Community Garden - 16 Hampshire St., Lowell (Centralville)Dane Street Community Garden - 6 Dane St., Lowell (Acre)North Common Community Garden - North Common Park, 413 Fletcher St. (Acre)Pawtucket Farm Wildlife Sanctuary Community Garden - 1413 Varnum Ave, Lowell

Please indicate your SECOND garden of preference. We encourage you to select gardens closest to your home.

Rotary Club Park Community Garden - 22 Richmond Ave. Lowell (Back Central)Smith St. Community Garden - 36 Smith St., Lowell (Lower Highlands)Armory Park Community Garden - 46-90 Westford St. (Lower Highlands)West 3rd Community Garden - 66 West Third St., Lowell (Centralville)Eagle Park Community Garden - 95 West 6th St., Lowell (Centralville)Hampshire Street Community Garden - 16 Hampshire St., Lowell (Centralville)Dane Street Community Garden - 6 Dane St., Lowell (Acre)North Common Community Garden - North Common Park, 413 Fletcher St. (Acre)Pawtucket Farm Wildlife Sanctuary Community Garden - 1413 Varnum Ave, Lowell

Communication Preferences

In which forms would you like us to contact you?

TextCallEmail

Do you give permission for the Community Garden Ambassador (non-MCGs staff) to contact you?

If Yes, which forms

Text onlyCall onlyEmail onlyText or CallText or EmailCall or EmailNo Preference

Do you need a Tall Bed for easier access?

Are you interested in being a Garden Ambassador?

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scholarship

Are you or your family part of any of the following programs:

WIC

EBT/SNAP

Food Pantry/Free Market

Free Meal Program

MassHealth/Medicaid

SSI (Social Security)

Public Housing

TAFDC (Welfare)

Medicare

Health Connector

YesNo, my family is not part of the above programs

Please check the programs you or your family be part of

WICEBT/SNAPFood Pantry/Free MarketFree Meal ProgramMassHealth/MedicaidSSI (Social Security)Public Housing TAFDC (Welfare)MedicareHealth Connector

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Additional Information

Emergency Contact Name

Emergency Contact Phone Number

Add a Garden Partner Contact?

Garden Partner Contact Name

Garden Partner Contact Email

Garden Partner Contact Phone

Neighborhood

The AcreBack CentralBelvidere Centralville DowntownLower HighlandsThe HighlandsPawtucketvilleSacred Heart South Lowell

Country of Origin

Number of people in your household:

Under 18

18-64

65 & over

How do you usually get to the garden?

WalkDrive myselfSomeone else drive meBusTaxiBikeOther

Where do you usually get the food that you and your family eat?

Grocery StorePharmacyFarmers markets or local farmsFood pantries or free meal programsMy own garden

Program Id

Contact Information