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Peninsula Cleanup
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CITY OF NASSAU BAY PENINSULA CLEAN-UP
Date: February 12, 2022
Event Sign-Up, Liability Release & Photo Authorization Form
The Volunteer understands that he/she is engaging in activities that may expose him/her to dangers both from known risks and unanticipated risks. By signing this form the Volunteer discharges and holds harmless the City of Nassau Bay and Keep Nassau Bay Beautiful and its representatives from any and all liability, claims, losses, suits, damages, and demands of whatever kind or nature arising or resulting from property damage, bodily or personal injury and/or death that may be caused by Keep Nassau Bay Beautiful negligence or otherwise.
By signing this form the Volunteer also understands that the City of Nassau Bay and Keep Nassau Bay Beautiful, its partners, and affiliates may use all photographic images, video or audio recordings, video or audio reproductions, films, radio or television broadcasts and any other reproductions of the activities without limitations. Permission is granted for use in any medium now known or hereafter developed, including printed media, video, still photography and the Internet.
Are You Signing Up for this Event as an Individual or Family / Household?
Individual
Family / Household
Selecting Family / Household will allow you to sign up all volunteers at the same address on one form.
Name
Address
City
Zipcode
Email Address
Volunteer Under 18 Years Old?
Yes
No
Does Volunteer Need a Letter of Participation?
Yes
No
Name (Volunteer #1)
Address
City
Zipcode
Email Address
Volunteer #1 Under 18 Years Old?
Yes
No
Add Another Volunteer?
Yes
No
Does Volunteer Need a Letter of Participation?
Yes
No
Name (Volunteer #2)
Volunteer #2 Under 18 Years Old?
Yes
No
Add Another Volunteer?
Yes
No
Does Volunteer Need a Letter of Participation?
Yes
No
Name (Volunteer #3)
Volunteer #3 Under 18 Years Old?
Yes
No
Add Another Volunteer?
Yes
No
Does Volunteer Need a Letter of Participation?
Yes
No
Name (Volunteer #4)
Volunteer #4 Under 18 Years Old?
Yes
No
Add Another Volunteer?
Yes
No
Does Volunteer Need a Letter of Participation?
Yes
No
Please List the Remaining Volunteers Names and Ages
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