Community Clean-up Liability Release Form
Please complete this Community Clean-up Liability Release Form to participate as a volunteer. Your information will remain confidential and is required for participation.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Read and agree to the liability release below to participate:
Signature
*
Submit
Submit
Should be Empty: