City Cleanup Event Request Form City Cleanup Form Name* First Last Organization (if applicable) Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Estimated Number of Volunteers* Cleanup Event Date* MM slash DD slash YYYY Cleanup Event Start Time* : Hours Minutes AM PM AM/PM Cleanup Event End Time : Hours Minutes AM PM AM/PM Any Additional Info We Should Know?Preferred Cleanup LocationCity Park (Boy Scout Field)City Park (Kiwanis Pavilion/Dog Park)City Park (Picnic Island)City Park (Rotary Park Pavilion)Boundless ParkClairmont ParkComfort Safety Zone ParkDoverdale ParkLake Street ParkMonument ParkNaylor Mill Forest TrailsNewton-Camden Tot LotRiverwalkRobins Nest ParkWaterside ParkWoodcock ParkIf you do not see your preferred cleanup location in the options below, please enter it in the field labeled 'other'Other Preferred Cleanup Location Rules/Waiver*Under no circumstances should the licensee and/or group make any alterations, install equipment, or make attempts to maintain areas except for trash cleanup. All trash must be properly bagged and left in the location agreed upon with the City. The City reserves the right to refuse or cancel this agreement for any reasonable cause. Every attempt will be given to provide the organization adequate notice of cancellation. WAIVER: The licensee and/or group agrees to defend, indemnify, and hold harmless the City, its officers, agents, and employees from and against any and all claims, demands, causes of action, and liability of any kind for, and by reason of any act or omission of said licensee and/or group. Additionally, the licensee further accepts the rental area “AS IS” and releases, discharges and waives the City from any and all rights of action, either legal or equitable, which he has or ever may have against the City by reason of use of the said rental area, excepting only any such injury or damage resulting from the willful acts of the City.I am familiar with and agree to all policies which regulate the use of the rental area and have made the participating members of our group familiar with the same. I accept responsibility on behalf of the group for the activity described in this agreement. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. I AGREE CAPTCHA
