Saturday September 26th, 2015
Registration time is 8:45am @ Twin Bridges Park
Cleanup begins at 9:00
Each participant must complete this form. Please Register Early!
Fax Forms to: 254-750-5602
Email form to: kwacob@gmail.com
Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: ____________________________________________________ Zip: ______________________
Phone: _______________ Email: ____________________________ Age: ______________________
Group : __________________________________________________
T-shirt size: _________ (Adult sizes: S, M, L, XL,) EMERGENCY NUMBER: _____________________
I, _______________________________, do hereby agree that I will indemnify and hold harmless Keep Waco
Beautiful its officers, members, agents and assigns, and the City of Waco from any and all liability or claims of injury of
whatsoever nature which may be incurred by me as a result of my voluntary participation in this project sponsored by Keep Waco
Beautiful on September 19th, 2015 including but not limited to the following activities:
Picking up trash and debris in designated clean-up areas - Bagging litter along designated sites, including waterways,
and/or collecting piles of trash and litter to be bagged - transporting debris to a collection site.
I further represent and certify to said Keep Waco Beautiful, its officers, members, agents and assigns that I am
physically able to do the various things enumerated above without limitation, and that I have no disabilities which might
prevent me from doing the same.
I consent to and authorize the use and reproduction of any and all photographs which you may take during this event. I
give Keep Waco Beautiful the right to use my name and photograph in all forms and media without compensation to me.
I certify that I am eighteen (18) years of age or older, or that my parent or court-appointed guardian has full knowledge
of my participation in this event and has given me permission to participate, as evidenced by his/her signature below.
_______________________________________________ ___________________________________
Volunteer Participant (If not 18 or older, parent/guardian must co-sign below)
Date
_______________________________________________ ___________________________________
Parent/Guardian (Undersigned has read the above and understands this waiver)
Date
300 Austin Ave, Waco, Texas 76703 • 254-750-5728 • Fax: 254-750-5602 • www.keepwacobeautiful.com • kwacob@gmail.com
An affiliate of Keep America Beautiful and Keep Texas Beautiful
Keep Waco Beautiful strives to make Waco a cleaner and more beautiful place to live, work and play!