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Square Foot Garden Program
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January 2021
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Info
Square Foot Garden Program
Keeble Shelter, Chahinkapa Park, Wahpeton - 5:30 p.m.
Please complete a form for
each participant
. Thank You!
First Name
First Name
Last Name
Last Name
Gender
Male
Female
Email Address
Email Address
Full Mailing Address
Street Address City, State ZIP
Adult/Child
Adult
Child
If Child, name of parent/guardian/mentor/chaperone?
Name of Adult Chaperone
If Child, which grade?
K
1
2
3
4
5
6
7
8
9
10
11
12
Race
This is used for reporting purposes only.
White
Black/African American
American Indian/Alaska Native
Asian
Native Hawaiian/other Pacific Island
White & Black
White & AI or AN
Black & AI or AN
White & Asian
Balance (other combinations)
Residence
This is used for reporting purposes only.
Farm
Non-Rural: Under 10,000
Town & City: 10,000-50,000
Suburb: Over 50,000
City: Over 50,0000
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