* 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 if the same as the crop address)

City Postal code Province

How would you like to be contacted?

What type of site? -- select -- business farm - commercial farm - hobby farm market other public - government public - other public - school residence

What type(s) of produce do you have?

What is the earliest date you estimate the produce 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 produce needs to be harvested? (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 harvest?

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

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

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

Do you have a compost we should put the windfall/rotten fruit in?

Do you wish to keep your 1/3rd or donate it to Salt Spring Island Farmland Trust? (details)

Are there any wildlife, hazardous plants or domestic animals 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 Food Share rep Other

I have read and understand the Owners Liability Waiver.