14th Annual Don’t Mess With Texas Trash Off Registration Form
City Wide Clean Up
Saturday April 14, 2007
9:00 a.m. Breakfast & Trash Rally @ Sugar
Land Town Square Plaza
2711 Town Center Boulevard, Sugar Land, TX 77479
10:00 a.m. Trash pickup begins at assigned site – Participant provides transportation
Each participant must complete this form. Please Register Early!
Fax Forms to: 281-313-5707
Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: ____________________________________________________ Zip: ______________________
Phone: _______________ Email: ____________________________ Age: ______________________
Group (i.e. AHS ROTC, Dulles NHS, etc): __________________________________________________
T-shirt size: _________ (Adult sizes: S, M, L, XL, XXL) EMERGENCY NUMBER: _____________________
I, _______________________________, do hereby agree that I will indemnify and hold harmless Keep Sugar Land
Beautiful its officers, members, agents and assigns, 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 Sugar Land
Beautiful on April 14, 2007 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 Sugar Land 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 Sugar Land 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
119 Brooks Street, Sugar Land, Texas 77478 • 281-313-5752 • Fax: 281-313-5707 • www.KSLB.org • vickigist@kslb.org
An affiliate of Keep America Beautiful and Keep Texas Beautiful
Keep Sugar Land Beautiful Educates and Engages Everyone to take responsibility for the environmental health of our community