09 CFMJC Forms

							                                    Registration Form
Participant 1: ____________________________________________________________________________________

Participant 2 (If from same household, otherwise please use an additional form):

________________________________________________________________________________________________

Address: ________________________________________________________________________________________

City: ______________________________________ State: _____________________ Zip code: __________________

Home Phone: ______________________________ Email Address___________________________________________




Jr. Chefs Participant Information

Parent/Guardian: _________________________________________________________________________________

Work Phone (Mother): ______________________________Work Phone (Father): ______________________________

Cell Phone (Mother): _______________________________ Cell Phone (Father): _______________________________



   Please check all that apply. Each session is $40 per person.
                                                                               Student 1         Student 2          Total
Saturday, June 27, 10am - 1pm “Stretching Your Food Dollar at the Farmers’
Market” Adult class
CFM at Howe Meadow/Old Trail School

Saturday, July 11, 10am - 1pm “Jr. Chefs”
CFM at Howe Meadow/Old Trail School

Saturday, July 18, 10am - 1pm “Jr. Chefs”
CFM at Howe Meadow/Old Trail School

Saturday, July 25, 10am - 1pm “Jr. Chefs”
CFM at Howe Meadow/Old Trail School

Saturday, August 1, 10am - 1pm “Jr. Chefs”
CFM at Howe Meadow/Old Trail School

Saturday, September 19, 10am - 1pm “Canning 101” Adult class
CFM at Howe Meadow/Old Trail School



                                                                                             Grand Total:




    Complete registration and authorization forms and remit with
    payment to:

    Countryside Conservancy
                                                                                                Countryside
    Attn: Jr. Chefs                          Phone: 330.657.2538                                Conservancy
    2179 Everett Road                        Fax: 330.657.2198
    Peninsula, Ohio 44264                    Email:                                  Supporting community-based food systems.
                                             farmersmarket@cvcountryside.org