2020 Garden Plot Application:
GARDNER’S NAME_____________________________________ ___
STREET ADDRESS_________________ _______________________
CITY________________ ___ STATE_ _______ ZIP_______ ________
HOME PHONE______ ______CELL______ _____WORK_______ ____
EMAIL ADDRESS____ ______ _______________________________
OTHER RESPONSIBLE PARTY(S)_____ ________________________
PLOT SIZE and FEES (circle plot size) * $5.00 senior discount 65+
Large 10x20 Medium 4x20 Small 4x10
$40.00 $30.00 $25.00
Release: Recognizing the risk and possibility of injury associated with participation in the
Miami Township Community Garden and in consideration of Miami Township offering the
program at a nominal fee and accepting the participants into the program and activities. I
for myself, my heir, my successors, administrators and assigns hereby release, discharge
and/or otherwise indemnify Miami Township, Clermont County, Ohio, The Board of Trustees
of Miami Township, as well as all employees and/or agents of these entities from any and all
claims by or on behalf of the participant, the participant’s heirs, administrators and assigns
as a result of participating in the Miami Township Community Garden. I further certify that I
am physically fit and capable of participating in all activities required by the Community
Garden and that participating in the Community Garden will not pose a risk of physical harm
to myself or any other participant in the gardening program.
Gardner Signature/s Date
* This application can be mailed or dropped off to the Miami Township Recreation Dept.
6101 Meijer Dr. Milford, OH 45150. Please include check made payable to: Miami Township
