2022 On Your Own River Clean Up Registration
Use this form to register for an on-your-own River Clean Up during the months of September and October.
Even if you are part of a group, we ask that each individual within the group registers.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email Address *
Re enter Email Address *
Home Address
Phone Number
Are you with a group?  If so, what is the name?
Preferred clean up location.  Identify a site of your own or use this link to view suggested sites: https://www.google.com/maps/d/edit?mid=1joF-i-EMs3tpH6DploPXnMmHri0euL8&usp=sharing 
When in September or October do you plan to conduct your cleanup? (it is OK to estimate) *
MM
/
DD
/
YYYY
Did you participate in the event on July 23rd?
Clear selection
How did you hear about the River Clean Up?
T-shirt size *
Special instructions or comments
Please read the Release and Waiver Liability statement below
Complete ONE of the following two options:
I am the participant listed at the top of this form and am at least 18 years of age. By typing my name below, I agree to the terms of the "Release and Waiver of Liability" above for myself.
Write YOUR NAME below if the participant is an adult.
The participant listed at the top of this form is under 18 years of age.  I am the parent or legal guardian of the above participant and by typing MY name below, I agree to the terms of the "Release and Waiver of Liability" above for myself and the participant.
Write YOUR NAME below if the participant is a child.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms