Chicken Coop and Urban Farm Tour Host Application 2016 Question Title * 1. First Name/Last Name Question Title * 2. Street Address Question Title * 3. Zip Code Question Title * 4. Phone number Question Title * 5. Email Address Question Title * 6. Seattle Neighborhood Question Title * 7. Farm Name Question Title * 8. Have you been a host on the tour before? Yes No Question Title * 9. I have homeowners/renter's insurance. Yes No Question Title * 10. Do you keep chickens? Yes No Question Title * 11. If so, please list your breeds. Question Title * 12. How long have you been keeping chickens? Question Title * 13. Coop Dimensions Question Title * 14. Run Dimensions Question Title * 15. Is your coop at least 10 feet away from any neighboring residential structure? Yes No Question Title * 16. Where is your coop located on your site, and how accessible/visible is it to the public? Question Title * 17. Which other animals do you keep? Goats Ducks Honey Bees Mason Bees Rabbits Question Title * 18. Other animals: Question Title * 19. Please list the breeds of the other animals you keep: Question Title * 20. Please select features of your garden & site: Worm bin Compost system Native plants Green roof Garden pathways Pollinator Pathways Permaculture Biodynamic agriculture Aquaponics Rain Barrels/Cisterns Question Title * 21. Do you have a food garden? Yes No Question Title * 22. If so, do you use organic practices? Yes No Question Title * 23. Please select other features of your food production: Sharing produce with others Selling produce Donating produce to a food bank Front yard or parking strip garden Signage or educational outreach around food gardening Perennials Year round food gardening Container gardening Vertical gardening (trellises, up walls, etc) Use of heirloom varieties Seed saving/sharing Companion planting/guilds Food preservation Question Title * 24. Does your garden/urban farm benefit the neighborhood? Please tell us how. Question Title * 25. What makes your garden unique and interesting for potential visitors? Why should it be featured on the tour? Question Title * 26. Site DescriptionPlease write a brief summary (1-2 sentences) of your coop, other animal home, food garden, animals and site for visitors. This information will be used to write the description on the tour map. It may have to be edited due to space constraints. Question Title * 27. Specialist categoriesWe’ll be giving out special awards in the following areas, along with a tour attendee vote for “People’s Choice”. Please indicate which we should consider you for! Animal House - Most interesting animals or coolest coop Community Star - Most community-oriented coop or garden Innovation Station - Most innovative or cutting edge gardening spaces Garden to the Max - Most diversely planted garden or efficient use of urban space Question Title * 28. Media ReferralSeattle Tilth receives inquiries throughout the year from reporters looking for people to interview and sites to photograph about raising animals or urban farming. Would you be interested in being one of our referrals for the media? You can be on the list and then say “no” to specific requests if the timing does not work for you. Yes! Add me to your referral list for the media No, thanks Question Title * 29. Photo & Application Use I give consent for Seattle Tilth to use photos and text that I am submitting for my application and photos taken on my site during the Chicken Coop and Urban Farm Tour for marketing or educational purposes in print or online. Yes Question Title * 30. Refer other hostsKnow other great potential hosts in your neighborhood that should apply? Send us their contact info! We try to group sites together within walking distance. Please include at least 2-3 photos of your coop and site!Ideal photos are focused, clear and 750 KB-3 MB in size (no larger than 3 MB please). Make sure these photos represent your site well and show off the best features. Email these photos to vandiep@seattletilth.org with your name. Thank you for applying! Please click the 'Done' button below to submit. Done