Waukon Power of Produce Kid's Club (PoP)

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The Power of Produce Kid's Club (PoP Club) is open to children age 4 through 12 from July 1 - August 5. Each child participating in the 6-week program will receive a reusable shopping bag upon at sign-up and $2 market bucks to spend fresh produce. Kids will receive a fun prize and additional bucks each week. Kids can choose to spend their bucks that day or save their money for a future market.

Child Last Name *

Your answer

Child First Name *

Your answer

Child Age *

Your answer

Gender *

Boy

Girl

Prefer not to answer

Parent Email *

Your answer

Home Zip Code *

Your answer

Photo Consent *

I grant permission for my child to be included in pictures and publicity related to the PoP Club.

Yes

My child is... (select all that apply): *

White

Black/African American

Hispanic or Latino

American Indian or Alaskan Native

Prefer not to answer

Other:

Does your family participate in at least one of the following programs: SNAP, WIC, and/or Free/reduced school lunch? *

Yes

Prefer not to answer

How long has your family attended the farmers market? *

This is our first year

2-5 years

6-9 years

10+ years

Did your family start attending the farmers market because of the PoP Kid's Club? *

Yes

How did your family hear about the PoP Kid's Club? *

Friend, relative, coworker

Farmers Market attendance

Social media

Newspaper

Flyer/poster

Other:

Parent E-Signature *

Your answer

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