* Owner's name or organization name

* Contact person's name

* Phone number Alternate phone number

Email address

Crop Address

City Postal code Province

Mailing address (leave blank it the same as the tree address)

City Postal code Province

How would you like to be contacted?

What type of site? -- select -- - New Site Type - business - rural business - urban farm - commercial farm - hobby farm market other public - government public - other public - school residence - commercial residence - private

What type(s) of fruit do you have?

What is the earliest date you estimate the fruit will be ready to pick?

-- month -- January February March April May June July August September October November December -- day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

How much fruit needs to be gleaned? (pounds, number of buckets, number and size of trees, etc.)

Has the crop been sprayed? (details)

Do you have preferred days or times for us to glean?

Do you have a ladder that be helpful in reaching the fruit? -select- Yes No

May we do a site visit when you are not at home? -select- Yes No

May we come get the fruit when you are not at home? -select- Yes No

Do you have a compost we should put the windfall/rotten fruit in? Where is it located? We can bring the windfall/rotten fruit in to CGC along with your donation if you do not want it.

Do you wish to keep your 1/3rd or donate it to Cowichan Green Community? (details)

Are there any bears, cougars, elk,other wildlife or pests or hazardous plants in the area that we need to be aware of? What time of day do they typically visit the site?

Are there any other details we should know (instructions, access codes, directions, etc.)?

This form was filled out by -select- Crop owner FruitSave rep Other

I have read and understand the Owners Liability Waiver.