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2019 Earth Day Community Cleanup
Important—You must complete each section!

If you are registering as an individual, group, organization or school, you will be assigned as the Site Captain. Keep Columbus Beautiful will provide a cleanup kit for each Site Captain, the kit will contain trash bags, gloves, a small first-aid kit, hand sanitizer, and a “Litter Tally Sheet”. Please complete and return the “Litter Tally Sheet” in the envelope provided immediately after your cleanup activities. Please plan to pick up your Site Captain bag on Wednesday, April 17, 2019, 11:00am-5:00pm at the Columbus Consolidated Government, Citizen Service Center, 3111 Citizen Way (off Macon Road next to the Columbus Public Library), in the 311 Call Center, behind the information desk. This will be the ONLY opportunity for you to pick up you cleanup supplies!

Email address *
Organization or School/ Individual Name *
Your answer
Number of Adults Participating in Cleanup *
Your answer
Number of Children Participating in Cleanup *
Your answer
Contact Person *
This individual will also be listed as the Site Captain
Your answer
Mailing Address City/State/Zip *
Your answer
Phone Number *
Your answer
Please check the appropriate box *
Required
Columbus Public Parks, April 20, 2019
If cleaning private property please provide the name of the community
Your answer
Cleanup begin location:
Your answer
Cleanup end location:
Your answer
I have been granted permission to participate in Earth Day Community Cleanup on April 19- April 20, 2019, do hereby waive any and all claims of liability for personal injury, death or property damage against Keep Columbus Beautiful, the Columbus, Georgia Consolidated Government, all elected officials thereof, and all directors, supervisors, officers, employees and agents of Columbus, Georgia. I further hereby release and indemnify Keep Columbus Beautiful, Columbus, Georgia, all elected officials thereof, and all directors, supervisors, officers, employees and agents of Columbus, Georgia, from all liability and responsibility that may be claimed or placed against such entity or persons by myself or others as a result of my participation. *
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