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Updated 1/2024 GARDEN PLOT REQUEST FORM PUYALLUP COMMUNITY GARDEN Location: 1111 19th AVE SW, Puyallup Instructions: Provide all requested information. Sign and date the form. Return this form and payment to: Mail: Puyallup Recreation Center, Attn: Community Garden, 808 Valley Ave NW, Puyallup, WA 98371 In Person: 808 Valley Avenue NW, Puyallup WA By fax:(253) 770-3369 Questions: (253)-841-5457 Name(s): City of Puyallup Resident? Yes* No Address: Home Phone: Cell/Work Phone: E-mail Address: Garden Plot Request: Plot Number (if known) Annual Fee Regular Rate Resident Discount* Single Plot (10’x10’) $36.00 $30.00 Additional Plots as available The undersigned hereby applies to the City of Puyallup for use of the above facilities and certifies the information is correct and furthermore agrees to abide by all ordinances, policies, and rules and regulations which may apply. The application shall indemnify and hold harmless the City of Puyallup, its elected and appointed officials, its employees and agents from and against any and all claims, demands, suits, action, payments and judgments as a result of injury or death of any person or property damage to any property sustained by applicant or any other persons which arise from or in any manner grow out of any act or omission on or about said facility by applicant, its agent, guest, or employees, in the execution of this rental agreement including any and all expenses, legal or otherwise incurred by the city or its representatives in the defense of any suit or claim. Such indemnity shall not include claims arising as a result of the sole negligence of the City of Puyallup its elected and appointed officials, its employees and agents. The applicant agrees to follow guidelines established by the City of Puyallup. Forms submitted to the City may be subject to public disclosure under the Washington State Public Records Act (RCW 42.56). Signature: Date: Printed Name: Fee Enclosed/Paid: OFFICE USE ONLY Date Received: By: Approved By: Date Amount Paid: Plot #