Conservation Week Clean-ups - Wellington Region
You're awesome!
This form is to request equipment to do your own beach cleanup.
We'll drop off gear to you at the address you supply and pick it up after your cleanup, this includes:

Reusable Sacks - One between three, please do not throw these away
Large Black Plastic Rubbish Sack - For securing rubbish for pickup
Health and Safety Assistance - We'll give you a clean-up guide with things to consider
Rubbish Pick up - We will organise council to pick up your rubbish, please follow instructions we send

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Approximately how many people are in your group? *
Your answer
What is your address for drop off? *
Your answer
What beach are you going to cleanup?
It's ok if you don't know at this point
Your answer
Do you hold a first aid certificate? *
Would you like to join the Sustainable Coastlines mailing list? *
Health and Safety Disclosure Acknowledgement
Please ensure that you read, understand and accept the information below.

Please be aware that this is not a Sustainable Coastlines event.

By requesting and accepting equipment you are fully responsible for yourself and your group and Sustainable Coastlines accepts no responsibility for the health and safety of your event

Events held outdoors expose you to risks during the course of the event including, (but not limited to): exposure to the elements, risks associated with boating, kayaking, walking on uneven surfaces including shorelines and rocks, driving off-road, walking on roads with vehicles constituting a hazard, collecting or handling rubbish (potential sharp objects, hygiene, sickness or other health-related risks).

I understand that there are risks involved in the activities I will be undertaking. I also understand that an unpredictable or uncontrollable event may occur that could possibly cause me serious harm or even death.

To the fullest extent permitted by law, I hereby waive any rights I may have to take legal action against Sustainable Coastlines, other participating organisations, sponsors (including the directors, officers, trustees and employees of all of the organisations listed above) and all other event participants with respect to any personal injury or property damage whether arising from negligence or otherwise, as a result of participation in an event using Sustainable Coastlines equipment

I furthermore express that it is not my intention that my estate should take any legal action against any of the organisations listed above (or any of their directors, officers, trustees and employees) should I lose my life during the course of this event or due to something caused by my participation in this event.

I permit that Sustainable Coastlines may use, own and distribute any photos and/or footage taken during the course of the event, for publicity, advertising, sale and distribution in perpetuity.

Acknowledgement and Acceptance *
Ensure that you read and understand the information above
Submit
Never submit passwords through Google Forms.
This form was created inside of Sustainable Coastlines. Report Abuse - Terms of Service - Additional Terms